Due in large part to the advocacy of the AMA, CMA, and other large state medical associations, the Centers for Medicare and Medicaid Services (CMS) has announced new rules that will reduce penalties and provide greater flexibility during the first year of ICD-10. This is welcome news in light of recent surveys showing that many physicians are currently unprepared for the shift to ICD-10.

The new rules are intended to provide flexibility in the event physicians and other providers utilize less specific ICD-10 codes than would otherwise be indicated, but they do not provide an extension or allow for the use of ICD-9 codes beyond October 1, 2015.  Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of services after September 30, 2015, nor will they be able to accept claims for both ICD-9 and ICD-10 codes with dates of service of October 1, 2015 and beyond.

Under the new rules:

  • Medicare contractors will not deny claims based solely on the specificity of the ICD-10 diagnosis code as long as a valid ICD-10 code from the right family of ICD-10 codes is used. Moreover, physicians will not be subject to audits as a result of ICD-10 coding mistakes during the grace period.
  • Physicians will not be penalized under various CMS quality reporting programs for errors related to the additional specificity of the ICD-10 diagnosis code, as long as a valid ICD-10 code from the right family of ICD-10 codes is used.
  • If Medicare contractors are unable to process claims within established time limits because of ICD-10 administrative problems, such as contractor system malfunction or implementation problems, advance payment may be available.

CMS also announced the establishment of a communication center and an ICD-10 ombudsman to help receive and triage physician and provider issues.

These new rules are the result of organized medicine's efforts to convince CMS of the need for a transition period to avoid financial disruptions during this time of tremendous change. CMA, AMA and other large state medical associations (New York, Texas and Florida) have been pushing for a two-year grace period during which physicians would not have claims delayed, denied or subject to audits because of simple ICD-10 errors.

ICD-10 Education and Training

There are numerous resources available to assist physicians with the transition, including many free resources listed below:

NOTE: ACCMA ICD-10 Boot Camps are scheduled for this Friday, July 10th in Concord and Saturday, July 11th in Oakland. Space is limited! To register, call (510) 654-5383 or email. ACCMA ICD-10 Boot Camps are scheduled for this Friday, July 10th in Concord and Saturday, July 11th in Oakland. Space is limited! To register, call (510) 654-5383 or email accma@accma.org.

Physicians are also encouraged to check with your specialty societies and other physician organizations for other ICD-10 training resources that may be available.

For questions, contact the ACCMA at (510) 654-5383, or by email at accma@accma.org.