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Two Weeks Until ICD-10 Deadline; Physicians Have Some Relief

Posted in Electronic Health Records, Home Healthcare, Hospitals and Institutions, Legislation and Public Policy, Medicare and Medicaid, Private Insurers, Reimbursement Matters

Beginning October 1, the Centers for Medicare & Medicaid Services (CMS) will not accept ICD-9 diagnosis codes for dates of service after September 30, and it will not send rejection notices. However, in July, the American Medical Association and CMS agreed to the following accommodations for physicians during a 12-month transition period to address possible payment disruptions caused by ICD-10 implementation:

(1) 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;

(2) CMS will not audit a claim if it uses a valid code from the correct family of ICD-10 codes;

(3) Medicare will not subject physicians or other eligible professionals to the Physician Quality Reporting System, Value-Based Payment Modifier, or Meaningful Use penalties, as long as the correct code family is used; and

(4) physicians may apply for advance payments if claims cannot be processed due to problems with ICD-10 coding.

See CMS’s FAQs.
In addition, CMS has named William Rogers, M.D. the director of the Physicians Regulatory Issues Team at CMS as the “ICD-10 ombudsman” devoted to triaging physician issues. Dr. Rogers can be reached at after ICD-10 goes live on October 1.

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