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ICD-10 is coming October 1st. Are you ready?

Wednesday, July 29, 2015

On Monday, CMS released answers to frequently asked questions to help clarify recently announced measures that aim to provide physicians with some flexibility as they transition to the new ICD-10 code sets, EHR Intelligence reports.

Background

U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures by Oct. 1.  On July 6, CMS and the American Medical Association jointly announced measures designed to help ease physicians’ transition.

Among other things, CMS said it would:

Appoint an ICD-10 ombudsman to help oversee the transition;

Establish a one-year grace period in which it will reimburse physicians under Medicare Part B for claims with incorrect ICD-10 diagnosis codes;

Extend the flexibility for quality code errors to the Physician Quality Reporting System, Value-Based Payment Modifier program and meaningful use program so physicians and other eligible professionals are not penalized; and

Provide a range of online resources — including Web conferences and training documents — to aid providers in the transition.

FAQ Details

CMS posted a list of 13 FAQs to clarify several aspects of the measures. For example, the agency noted that:

The ICD-10 ombudsman will be in place by Oct. 1;

The measures do not signify an ICD-10 delay;

Submitters whose claims are denied will be notified with an explanation of the rejection;

Submitters should follow existing processes for correcting and resubmitting rejected claims (Goedert, Health Data Management, 7/28);

The measures only apply to Medicare fee-for-service claims;

The guidance does not apply to Medicaid claims, but each state will be “required to process submitted claims that include ICD-10 codes for services furnished on or after Oct. 1 in a timely manner” (EHR Intelligence, 7/28); and

The measures do not apply to commercial payers, which “will have to determine whether [to] offer similar audit flexibilities”.

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