For a one-year period starting Oct. 1, Medicare claims will not be denied or audited solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submits an ICD-10 code from an appropriate family of codes, according to the new guidance. The guidance also states that CMS will not penalize providers reporting for quality programs if the agency has problems calculating quality scores because of the new codes. Additionally, CMS will create an ICD-10 ombudsman to help providers with problems during implementation and authorize advanced payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation.
“The ICD-10 guidance issued yesterday is an important step toward establishing a reasonable and responsible transition to the ICD-10 code set,” said Dr. Bill St.Clair, President of the ACR and a practicing rheumatologist. “The ACR has been a vocal advocate for safe harbor protections, specifically those outlined in the ICD-TEN Act (H.R. 2247). The new guidance addresses many of our members’ concerns about the impact of ICD-10 on small and rural practices, and we will continue to work to ensure a stable transition in other areas.”
The ICD-TEN Act (H.R. 2247) is a bill introduced by Representative Diane Black (R-TN) that has bipartisan support among U.S. lawmakers and would provide a reasonable and responsible transition to ICD-10. As the U.S. healthcare system transitions from the current ICD-9 medical coding set to the updated ICD-10 system, the legislation would institute an 18-month “safe harbor” period after the October 1, 2015 implementation date, during which time physicians would not be financially penalized for minor mistakes due to sub-coding errors. The current CMS guidance only offers protections for one year after implementation. The ACR also urges private payers to adopt similar safe harbor protections.
“With the Oct. 1 implementation date fast approaching, the ACR will encourage CMS to act on its issued guidance while continuing to push for the full 18-month period and policies that ensures our nation’s physicians do not experience undue financial instability as a result of this sweeping technological overhaul,” added Dr. Will Harvey, chair of ACR’s government affairs committee. “We will continue to support the bipartisan ICD-TEN Act as the most common-sense, bipartisan solution, and we encourage other healthcare providers and policymakers to do the same.”