Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) teamed up to help doctors ease into the transition for ICD-10 on October 1, 2015.
Here’s a quick overview of the Guidance regarding ICD-10 flexibilities. The Guidance is for all services paid under the Medicare Fee-for-Service Part B physician fee schedule.
- Claim Denials. For 12 months, Medicare claims will not be denied solely based on the specificity of diagnosis codes, as long as they are from the appropriate family of ICD-10 codes.
- Quality-Reporting Penalties. CMS will not impose penalties for the Physician Quality Reporting System, value-based payment modifier, or meaningful use based on the specificity of diagnosis codes, as long as they use a code from the correct ICD-10 family of codes.
- Payment Disruptions. CMS can authorize advance payments, if Medicare contractors are unable to process claims as a result of problems with ICD-10. To apply for advance payment, the doctor is required to submit the request to their appropriate Medicare Administrative Contractor (MAC).