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.

Steven Andrews is editor of Briefings on APCs and outpatient editor of JustCoding.com.

http://www.healthleadersmedia.com/content/TEC-318237/CMS-No-ICD10-Audit-Claims-for-Specificity-in-Year-One.html

On December 17, 2013, CMS is hosting a call to provide an overview of the quality reporting provisions in the 2014 Physician Fee Schedule (PFS) final rule

On December 17, 2013, CMS is hosting a call to provide an overview of the quality reporting provisions in the 2014 Physician Fee Schedule (PFS) final rule (which has not yet been released). The call will provide details on how an eligible professional or group practice can meet the criteria for satisfactory reporting for the 2014 Physician Quality Reporting System (PQRS) incentive and 2016 PQRS payment adjustment (including a discussion of criteria for satisfactory participation under the new qualified clinical data registry option). The call also will provide updates on the Electronic Health Record (EHR) Incentive Program and Physician Compare.

The Centers for Medicare and Medicaid Services has released a fact sheet on participating in the 2013 Physician Quality Reporting System/Medicare Electronic Health Record Incentive Pilot Program.

Under the program, eligible professionals can meet Stage 1 meaningful use clinical quality measure reporting requirements while also reporting for the PQRS program by submitting their clinical quality data electronically. Participating physicians must submit 12 months of CQM data between Jan. 1 and Feb. 28 of 2014.

The six-page fact sheet covers determining eligibility for the program, indicating intent to participate, verifying that an EHR vendor is PQRS-certified and the EHR is MU-certified, choosing measures to report, generating required reporting files, and submitting test data prior to data submissions for payment, among other issues. 

The fact sheet is available here.

http://www.cms.gov/eHealth/downloads/CMS_PQRS_ParticipationDocument.pdf?utm_medium=email&utm_source=govdelivery