Friday, July 10, 2015
Tuesday, July 7, 2015
For one year after implementation of ICD-10, CMS will not deny or audit claims just for specificity, as long as the code is from the appropriate family of ICD-10 codes. Similarly, physicians will not be penalized for the value-based payment modifier or Meaningful Use due to specificity of diagnoses.
After a vigorous, last-ditch push by the AMA for a two-year transition period after implementation to protect physicians from all ICD-CM coding errors and mistakes, CMS and AMA made a joint announcement that appears to signal a burying of the hatchet.
Steven Stack, MD, AMA's president, touts the changes in a post that begins with a concession his group has resisted stating for years: "Implementation of the ICD-10 code set is just around the corner, with a hard deadline of Oct. 1."
To gain that admission from the AMA, CMS agreed to a variety of policies involving claim denials, quality reporting, payment disruptions, and navigating the transition.
For one year after implementation, CMS will not deny or audit claims just for specificity, as long as the code is from the appropriate family of ICD-10 codes. Even though the use of unspecified codes is allowed according to the ICD-10-CM Official Guidelines for Coding and Reporting, this clarification makes a lot more sense than absolving physicians of all coding errors and mistakes.
Similarly, CMS will not penalize physicians for the Physician Quality Reporting System, the value-based payment modifier, or meaningful use to due specificity of diagnoses as long as the provider reports a code from the appropriate family.
CMS has also authorized advance payments to physicians if Medicare contractors can't process claims due to problems related to ICD-10.
CMS will continue to offer resources to aid practices with a new ICD-10 communications and coordination center headed by an ombudsman to resolve outstanding questions about implementation.
For more information, see CMS' guidance on the changes.
The biggest benefit to the healthcare community is that the announcement has finally removed the biggest barrier to implementation: uncertainty. You can now talk to physicians confidently about the ICD-10 deadline and work with them throughout the yearlong transition to improve their documentation for you to choose the most appropriate, and specific, code.
You can forget about delays, waiting for ICD-11, and any other excuses you've heard about pushing off training for the transition. With the AMA and CMS working together, ICD-10 is certainly coming in just 86 days.
Friday, July 3, 2015
At the beginning of 2015, CMS began reimbursing physicians for the care they provide to a particular group of their Medicare patients remotely and between visits. This new billing code, called Chronic Care Management (CCM), required that this remote care meet a few criteria, like patients must have two or more chronic conditions; the physician must establish a comprehensive care plan for the patient; and the remote care must take up at least 20 minutes of staff time over the course of the month.
This week CMS issued a proposed rule that seeks to clarify the use of the CCM billing code based on the many inquiries the agency has received since the code first came out.
“In reviewing the questions from hospitals on billing of CCM services, we identified several issues that we believe need to be clarified. Therefore, for CY 2016 and subsequent years, we are proposing additional requirements for hospitals to bill and receive OPPS payment for CPT code 99490. These proposed requirements, discussed below, are in addition to those already required…” CMS writes.
CMS proposes that starting next year CCM can only be billed to if patient has an already established relationship with the provider using the code. “While we have always expected the hospital furnishing the clinical staff portion of CCM services, as described by CPT code 99490, to have an established relationship with the patient and to provide care and treatment to the patient during the course of illness… we have not previously specified through notice-and-comment rule making that the hospital must have an established relationship with the patient as a requirement for billing.” This prior relationship requirement would be an “explicit condition” on billing to the code, if the proposal is adopted.
CMS also wanted to clarify that while it was previously stated that only one physician can bill for the code for a given patient, the same goes for one hospital for a given patient. “The physician or other appropriate non-physician practitioner directing the CCM services should inform the beneficiary that only one hospital can furnish and be paid for these services during the calendar month service period.”
For more on CMS’ proposed changes and clarifications to CCM and other billing codes, check out the full proposal here (PDF).