There are less than 3 months before the switch to ICD-10 for medical diagnoses and inpatient hospital procedures. The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) are continuing their efforts to help providers get ready before the October 1st deadline. CMS has made available additional resources to assist providers with this transition while allowing for flexibility in claims auditing and quality reporting process. These efforts include:
- CMS and AMA will help educate providers through webinars, on-site training, educational articles and national provider calls.
- Easy to use tools, a new Ombudsman, and added flexibility in their claims audit and quality reporting process.
- CMS’ “Road to 10”, a no cost initiative, is focused on smaller physician practices with primers for clinical documentation, clinical scenarios, and other specialty-specific resources including provider training videos that offer helpful ICD-10 implementation tips.
- The AMA has developed a broad range of materials to help physicians prepare for the October 1st Please visit the “AMA Wire” to learn more and access these developments.
For more details including CMS’ operating plans for the ICD-10 implementation including upcoming milestones, please see the AMA & CMS Joint Press Release.
In addition to the above information resources, CMS has stated that they will not deny claims with certain ICD-10 errors for one year for Part B providers. They will have one more year after the October 1st ICD-10 implementation to get their diagnosis coding exactly correct. Lack of code specificity will not cause claims denials for Part B providers. Medicare Administrative Contractors (MACs) and recovery auditors (RACs) will be instructed to not deny claims based solely on the specificity of the ICD-10 diagnosis code as long as a valid code from the right family is used. More details are available in the FAQs that accompany the AMA-CMS Announcement and can be found using the “additional resources” link. See Questions #2.
Please note that while the correct level of specificity is the goal for all claims, for 12 months, Medicare review contractors will not deny physician or other practitioner claims billed under Part B physician fee schedule through either automated or complex medical record reviews solely on the specificity of the ICD-10 code. However a valid ICD-10 code will be required on all claims starting on October 1st.
Click HERE to download a copy of this Merlino Healthcare Consulting Corp. Coding tip.