How to Address ICD-10 Issues

ICD-10-logoWith the Oct. 1 ICD-10 implementation date behind us, the AMA has revised its online ICD-10 information and resources. If physicians experience any problems with the processing of claims or other administrative transactions, they should take the following steps.

Medicare advance payment for ICD-10 problems

CMS has announced that MACs will issue advance payments in situations where claims cannot be processed within established time limits because of administrative problems, such as contractor system malfunction or ICD-10 implementation problems. An advance payment is a conditional partial payment and will require repayment.

To apply for an advance payment, the physician is required to submit the request to their appropriate MAC. Should there be Medicare systems issues that interfere with claims processing, CMS and the MACs will post information on how to access advance payments. CMS does not have the authority to make advance payments in the case where a physician is unable to submit a valid claim for services rendered.

CMS issues additional ICD-10 question and answers

On Sept. 22, CMS updated “Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities,” providing further clarification on issues such as prior authorization requirements, Medicare Advantage claims and coding guidelines.

Information from the AMA Advocacy Update, 10-9-15.