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CMS Agrees to ICD-10 Grace Period

icd-graphic-v1.0-06CMS Agrees to ICD-10 Grace Period – The American Medical Association and Centers for Medicare and Medicaid Services (CMS) jointly announced that an agreement has been reached on important elements of a “grace period” for the October 1, 2015, implementation of the ICD-10 diagnosis code set.

In guidance that is being transmitted, CMS announced that:

  • For a one year period starting October 1, Medicare claims will not be denied solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes. In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes. This policy will be followed by Medicare Administrative Contractors and Recovery Audit Contractors.
  • To avoid potential problems with mid-year coding changes in CMS quality programs (PQRS, VBM and MU) for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores (i.e., for PQRS, VBM or Meaningful Use). 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 provider problems that need to be resolved during the transition.
  • CMS will authorize advanced payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation.

The AMA plans to monitor and keep CMS apprised of any implementation issues that persist in 2016, and will urge the agency to make any needed adjustments to the grace period policy and time line based on new information that surfaces during the implementation process.

The October 1 deadline for implementation of the ICD-10 code set is fast approaching, and time is running out for physician practices to complete their preparation. Visit the CMS website for this information and for this information.

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