The Medicare program recently announced a grace period of 1 year for claims that bear ICD-10 diagnostic codes.
Claims for payment will not be rejected by Medicare even if the submitted ICD-10 codes lack specificity.
Physicians who were concerned that even minor errors might stop their payment once ICD-10 is implemented have experienced some relief with this grace period and other efforts being made by the CMS.
| According to the CMS, claims will not be rejected due to lack of code specificity as long as the code submitted is in the right ICD-10 family |
| Physicians will not be penalized if they submit data which contains less than perfect ICD-10 codes to Medicare quality programs this year such as PQRS |
| As per CMS, physicians will be able to ask for partial advance payments if its claims-processing contractors fail to process Medicare claims bearing new codes due to problems on their end such as, implementation problems or contractor system malfunctions |
Medicare review contractors will not be denying practitioners or physicians’ claims that are billed under Part B physician fee schedule through complex medical record review or automated medical review based on the ICD-10 code specificity. This will be done as long as a valid code is being used from the right family.
Besides the grace period, CMS will also be setting up an ICD-10 communication centre to provide assistance to physicians during the transition. It has plans to develop a strong collaboration and communication platform that can track implementation issues related to ICD-10 and also help in preventing minor errors in ICD-10 coding.
To understand issues of providers, ICD-10 Ombudsman has been established to help in solving issues in an efficient manner.
Physicians won’t have to suffer from audits or source verification challenges when it comes to quality reporting. This is because use of incorrect specificity of ICD-10 diagnostic codes in 2015 will be considered a part of the minor errors for which physicians have been given relief from the CMS. The only criteria they need to fulfill would be the choice of ‘correct family of codes’.
Advance payment is mainly a type of partial payment with conditions. This will require repayment and it might be issued when physician offices meet conditions that are described in CMS regulations. They will have to submit the request for advance payment to the MAC (Medicare Administrative Contractor).
Even though the CMS has allayed the fears of many physician practices for one year, they still need to be prepared for the coding complexities once the grace period ends. Growing number of physician practices have outsourced their revenue cycle needs to MBC. They are relying on the expert coding and billing team of MBC to help them sail through revenue challenges post ICD-10. It has not only helped them eliminate the hassles of meeting deadlines, training and hiring staff, updating of processes but also ensured them timely payments for each rendered service.
