CMS announces: We will be flexible with ICD-10

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After years of heated debate and frustration between the medical community and the Centers for Medicare and Medicaid Services (CMS), the 35-year old diagnoses codes doctors once used to bill for patient care under the CMS system are going by the wayside. Starting October 1, 2015, providers across the U.S. will replace ICD-9 with ICD-10—a coding set that includes 68,000 new medical diagnoses codes and a significant amount of trepidation for providers.

But there may be hope ahead. In a statement released in early July, CMS made the announcement that while all providers must use the new ICD-10 codes starting Oct.1, the group will make some concessions to help providers ease into the system more smoothly. These include:

  • More lenient claim denials. As long as providers are using the right code family, CMS reviewers will not deny claims for the Part B physician fee schedule based solely on the ICD-10 code. Providers will be able to utilize this option until October 1, 2016.
  • Quality reporting fees waived. For the 2015 year, Medicare quality reviewers will not subject providers to Meaningful Use, Value Based Modifiers, or Physician Based Quality Reporting System penalties as long as the provider used a code from the correct family. Providers will also be released from penalties if CMS experiences difficulty calculating necessary quality scores.
  • Advanced payments. According to a statement made by American Medical Association president Steven Stack, MD on their website, “If Medicare contractors are unable to process claims as a result of problems with ICD-10, CMS will authorize advance payments to physicians.”
  • Building resources for providers. In an effort to put resources in the hands of providers, CMS is offering a communication center complete with Ombudsman who will help clinicians resolve billing issues. Additional resources including webinars, videos and a website dedicated to only ICD-10 preparation has been available for some time.

Despite suggestions from lawmakers to use dual coding (both ICD-9 and ICD-10) during the transition, CMS denied this option. The group stands firmly by their stance that moving to ICD-10 now will improve not only patient care, but bolster earlier awareness of pandemic diseases like Ebola.

With just months to go, CMS is still encouraging lagging providers to get on board. There is still time to prepare, and these new concessions by the group will make what feels like a challenging process easier.