CMS Will Provide Flexibility for ICD-10 Claims

By Lea Chatham  |  July 13, 2015
ICD-10 Resource CenterCMS and AMA have announced efforts to offer options to ease the transition to ICD-10. The announcement comes as practices continue to struggle with readiness. This does not delay ICD-10. The deadline is still October 1, 2015. However, there will be flexibility, including:
  1. A new communication and collaboration center for ICD-10 implementation. This center will identify and work to resolve issues resulting from the ICD-10 transition. According to CMS, the center will also include an ICD-10 Ombudsman to triage provider issues and address concerns.
  2. Claims will not be denied based solely on the specificity of the ICD-10 code as long as it is a valid ICD-10 code from the correct family of codes for the diagnosis. A claim could still be reviewed, held up, denied or rejected for other reasons.
  3. For all quality reporting programs (MU, PQRS, VBM), eligible professionals (EPs) and providers will not be subject to a penalty during primary source verification or auditing related to additional specificity of the ICD-10 codes as long as the code used is from the correct valid family of ICD-10 codes. In addition, CMS has stated that “an EP will not be subjected to a penalty if CMS experiences difficulty calculating the quality scores due to the transition to ICD-10.”
  4. Advanced payments may be available in certain situations related to the ICD-10 transition. When a Part B Medicare Contractor is unable to process claims within established time limit because of administrative problems, and advanced payment may be available. The payment would be a conditional partial payment. CMS and the Medicare Administrative Contractors (MACs) will post instructions for applying for an advanced payment if there are claims processing delays for administration reasons.
The added flexibility has more to do with CMS providing extra time for providers to work towards increasing specificity in documentation and coding. In all cases, a correct, valid ICD-10 code must still be used, and it must be in the right family of codes for the diagnosis. You can read the complete guidance from CMS here.

While it is certainly nice to have a little added flexibility from CMS, it is not an excuse to delay preparations for ICD-10. Tweet this Kareo story
The change will still happen on October 1, 2015. All dates of service from that point forward will still need valid ICD-10 codes. Your practice still needs to train staff, work on code mapping and documentation improvement, and set aside cash reserves or get a line of credit to help support your practice after the deadline. The chance of processing delays and denials is still higher for the first few months from both CMS and your commercial payers.

To get regular updates on ICD-10 along with tips and tools for success, visits the Kareo ICD-10 Resource Center.

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