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Documentation Tip of the Week: CMS to Make ICD-10 Transition Less Disruptive for Physicians

Posted on Wed, Jul 22, 2015
Documentation Tip of the Week: CMS to Make ICD-10 Transition Less Disruptive for Physicians

Our weekly feature of documentation tips for clinicians.

One year “grace period” beginning October 1

The Centers for Medicare & Medicaid Services (CMS) announced it is making several critical changes to the ICD-10 transition period so physicians can continue to provide high-quality patient care without risking their
livelihood.

These changes address:

 

  • Claim denials: For the first year ICD-10 is in place, Medicare claims will not be denied solely based on the specificity of the diagnosis codes as long as they are from the appropriate family of ICD-10 codes. This means that Medicare will not deny payment for these unintentional errors as practices become accustomed to ICD-10 coding. In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes. This transition period will give physicians and their practice teams time to get up to speed on the more complicated code set. Both Medicare Administrative Contractors and Recovery Audit Contractors will be required to follow this policy.
 
  • Quality-reporting penalties: Similar to claim denials, CMS will not subject physicians to penalties for the Physician Quality Reporting System, the value-based payment modifier or meaningful use based on the specificity of diagnosis codes as long as they use a code from the correct ICD-10 family of codes. In addition, penalties will not be applied if CMS experiences difficulties calculating quality scores for these programs as a result of ICD-10 implementation.
 
  • Payment disruptions: If Medicare contractors are unable to process claims as a result of problems with ICD-10, CMS will authorize advance payments to physicians.
 
  • Navigating transition problems: CMS has said it will establish a communication center to monitor issues and resolve them as quickly as possible. This will include an “ICD-10 ombudsman” devoted to triaging physician issues.


Dr. Timothy Brundage
 

Timothy Brundage, MD, is a hospitalist for EmCare at St. Petersburg General Hospital in St. Petersburg, Fla. Dr. Brundage earned his bachelor’s degree in chemistry and molecular biology at the University of Michigan, his medical degree at the Wayne State University School of Medicine and completed his residency in internal medicine at the University of South Florida College of Medicine. Subscribe to Dr. Brundage’s weekly documentation tips or ask him about specific documentation issues by emailing him at DrBrundage@gmail.com.

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Tags: ICD-10

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