With less than three months remaining until providers are required to make the transition to ICD-10, the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) have announced efforts to continue to help physicians get ready ahead of the October 1 deadline.

In response to requests from the provider community, CMS is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD-10 code set.

Key points include the following:

ICD-10 Claims Processing & Denials

While a valid ICD-10 code will be required on all claims starting on October 1, 2015, for 12 months after implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule based solely on the specificity of the ICD-10 diagnosis code as long as they used a valid ICD-10 code from the right family of codes.

CMS ICD-10 Communication & Collaboration Center

CMS will set up a communication and collaboration center for monitoring the implementation of ICD-10 and address issues during the transition. An ICD-10 Ombudsman will be available to help receive and triage physician and provider issues.

Quality Reporting  

For program year 2015, Medicare clinical quality data review contractors will not subject physicians or other Eligible Professionals (EP) to the PQRS, VBM, or MU penalty during primary source verification or auditing related to the additional specificity of the ICD-10 diagnosis code, as long as the physician/EP used a code from the correct family of codes.  Furthermore, an EP will not be subjected to a penalty if CMS experiences difficulty calculating the quality scores for PQRS, VBM, or MU due to the transition to ICD-10 codes.

Providers are encouraged to ready their practices to make the October 1 transition by training staff now to give ample time for testing and adapting their coding process before the deadline.

Additional information can be found in the CMS guidance document or by visiting the CMS website.  A copy of the joint CMS-AMA announcement is available on the CMS website.

The UCF REC is your resource for ICD-10 Training   

We offer a variety of training options to prepare your practice for the October 1 deadline, including workshops at our corporate office, online or customized trainings for your practice on-site or via remote classes. The trainings can also be tailored by specialty and to a specific audience: physicians/clinicians, experienced coders or novice coders/front office staff.

Our upcoming training workshops and webinars are always available on our website.

For training inquiries, call: 407-309-4789 or e-mail  ICD10info@ucf-rec.org