CMS won't deny claims for first year of ICD-10 transition

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The Centers for Medicare & Medicaid Services announced it will work with the American Medical Association to ease the transition to ICD-10, including a 12-month grace period when claims won't be denied for unintentional code errors.  ICD diagnosis and procedural codes are used universally by long-term care providers and others on the care spectrum.

Despite previous disagreements on the topic, CMS has agreed to implement changes proposed by the AMA to make the transition to ICD-10 easier for providers. The biggest change is the creation of a 12-month transition period where Medicare claims won't be denied or audited based on the specificity of the diagnosis codes as long as they come from the correct family of codes.

“This means that Medicare will not deny payment for these unintentional errors as practices become accustomed to ICD-10 coding,” said AMA President Steven Stack, M.D., in a viewpoint piece. “This transition period will give physicians and their practice teams time to get up to speed on the more complicated code set.”

The changes also include exempting physicians from Physician Quality Reporting System, Value Based Modifier, or Meaningful Use 2 penalties as long as they use a code from the correct code family. Additional proposed changes include CMS authorizing advance payments to physicians if Medicare contractors are unable to process claims due to problems with ICD-10, and creating an ICD-10 communications center and ombudsman to monitor and resolve issues.