Tuesday, July 7, 2015

CMS: No ICD-10 Audit Claims for Specificity in Year One

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.


1 comment:

  1. I got diagnose of herpes virus last year, and i was taking some drugs prescribed for me by my family doc the drugs could not work and the herpes in my system was very terrifying that i was so depressed the good news is that i never gave up in searching for natural cure for herpes virus ,cause i believe so much in herbal medication.. One faithful morning i read a comment from a lady called Destiny Hudson on how she was cured with natural herbs made by DR.OYAGU from somewhere is West Africa, i immediately copied out his contact email via oyaguherbalhome@gmail.com and explain all my herpes problem to him via his email. the big truth is that it took just two week for his herbal medication to cure me completely without side affect. Till date am herpes virus free and all thanks to Dr OYAGU for his good deeds for me, Once again am very happy to share this great testimony of DR OYAGU cure hurry up now and contact him via his email address (oyaguherbalhome@gmail.com Call & WhatsApp him on (+2348101755322 ) and see what he can do

    ReplyDelete