You may have felt the collective sigh of relief on July 6 when the CMS announced that they will be implementing a year-long transition period to give providers—especially practices with limited resources—a little leniency and extra time to prepare for the coding switch.
Although many healthcare providers and organizations around the country were calling for yet another delay to the ICD-10 coding conversion, the Center for Medicare and Medicaid Services (CMS) remained firm on the October 1 deadline. Although the steadfast conversion date remains, it seems they have loosened the grip a bit on potential penalties resulting from ICD-10 implementation.
The AMA helped broker the more lenient ICD-10 requirements, which AMA President Steven A. Stack calls a “culmination of vigorous efforts” that show the “power of organized medicine”.1
The CMS announcement included four major changes that soften ICD-10 requirements and penalties, all of which will help the private practice physician stay independent and profitable during the transition.
1. Claim denials.
Claims will not be denied based solely on the lack of code specificity as long as providers have submitted the claim with the correct ICD-10 code family. The code still needs to be submitted at the expected digit level as specified in coding standards. Example a 7-digit code must be submitted with 7 valid digits.
The CMS had estimated that Medicare claim denials could increase in the months following the ICD-10 conversion,2which could’ve caused cash flow disruption, especially for practices that rely heavily on Medicare dollars. This change gives healthcare providers a little penalty-free room to breath as they become accustomed to new coding procedures.
2. Quality reporting requirements.
Penalties will not be issued for Physician Quality Reporting, Meaningful Use, or value-based payment modifiers as long as the appropriate code family is used.
The CMS extended the same softer coding requirements for reporting as they did for claim submission. For the first year of ICD-10, providers won’t receive CMS penalties based solely on the lack of coding specificity. Additionally, the CMS announced they will not issue penalties if they have difficulty calculating quality scores due to the ICD-10 conversion.
3. Advance payments.
CMS will authorize advanced payments if Medicare contractors have difficulty in claim processing as a result of ICD-10 implementation.
It’s not just physicians who are scrambling to prepare for ICD-10; there seems to be some doubt that all Medicare contractors will be ready for the conversion. This change means that payments will still be issued if ICD-10 challenges leave contractors unable to process physician reimbursements.
4. ICD-10 transition help.
A CMS ICD-10 communication center will be established to communicate transition problems.
To help navigate the turbulent waters created by the ICD-10 conversion, the CMS will establish a center to communicate the individual transition challenges and complaints of healthcare providers around the country. The center will be headed by a new appointed “ICD-10 ombudsman” who will be dedicated to the concerns of physicians.
Read the full CMS press release about the transition period for more details.
Stay the course!
Although these new changes may be a godsend for practices struggling with the demands of ICD-10 implementation, they shouldn’t be a distraction from ICD-10 preparation. If you need extra ICD-10 help, check out comprehensive library of resources designed specifically for today’s small independent physician practice.
1 Stack, Steven. “CMS to make ICD-10 transition less disruptive for physicians.” AMA Wire. Medical Economics, 6 July 2015.
2 Kreimer, Susan. “Claim Denials: 15 ways to fight back.” Medical Economics. Medical Economics, 8 May 2014.