ICD-10 GRACE PERIOD DOESN’T LET DOCTORS OFF THE HOOK
On July 6, the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association responded to concerns over the transition to the ICD-10 medical billing and coding system by announcing a “grace period” to help physi- cians implement ICD-10. CMS requires physicians to use the new coding system beginning Oct. 1. Elements of the grace period include:
• For one year beginning Oct. 1, Medicare will not deny claims solely on the specificity of the ICD-10 diagnosis codes as long as the physician submitted an ICD-10 code from an appropriate family of codes. Medicare will also not audit claims based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes.
• To avoid potential problems with midyear coding changes in CMS quality programs (Physician Quality Reporting Sys- tem, value-based payment modifier, and meaningful use) for the 2015 reporting year, physicians using the appropri- ate family of diagnosis codes will not be penalized if CMS experiences dificulties in accurately calculating quality scores. CMS will continue to monitor implementation and adjust the duration if needed. CMS will establish an ICD- 10 ombudsman to help receive and triage physician and health professional problems that need resolution during the transition.
• CMS will authorize advance payments if Medicare contrac- tors are unable to process claims within established time limits because of problems with ICD-10 implementation.
For more information on the ICD-10 grace period, visit
www.texmed.org/theicd-10graceperiod.
Fee Schedule had made their way into payment notices, making it look as if health professionals were overbill- ing patients. (See “TMA Uncovers Medicare Mistakes,” July 2015 Texas Medicine, pages 24–31, or visit www
.texmed.org/MedicareMistakes.) More recently, Ms. Ream dealt with
a situation in which Medicare sent AIMA a mysterious electronic pay- ment for about $8,600. She queried Medicare, which determined CMS meant to send the payment to another provider. CMS sent a demand letter for return of the payment. Insurers keep the office on its col-
lective toes, too. On one day in mid- July, Ms. Ream says, AIMA received letters from two insurance companies. One provided notice that it would re- quire more primary care doctor preau- thorization for certain tests. The other insurer gave notification that its fee schedules would change in October, and the fee schedules would be online on Oct. 1. “Well, Oct. 1 is when it’s changing,
and that’s when I’m going to be able to find it online? Okay, that’s very help- ful,” Ms. Ream said. “And I’m thinking in my mind, I’m so glad I can throw those things away because I’ve already sent our resignation letter to them.”
ICD-10 BRINGS THE END Earlier this summer, CMS alleviated fears many doctors had about the ICD-10 transition when it announced a plan to give physicians help and flex- ibility in implementing the system by the Oct. 1 deadline. But physicians still expect ICD-10
to bring headaches, and before the CMS announcement, AIMA’s doctors decided they didn’t want any part of those headaches, announcing the practice’s closing in an April letter to patients. With 26 days of breathing room
between its closing date and the date CMS requires the switch to ICD-10, AIMA will keep the coding in its re- cords clear of any transitional hiccups. “Of all the hassle factors, it’s down
36 TEXAS MEDICINE September 2015
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