CMS has released additional guidance for ICD-10 that will allow for greater flexibility in claims auditing and quality reporting to help providers transition to the new coding and billing sets.
There are four key changes to know.
1. Providers will have a one-year transition period. During the first year of ICD-10, providers' Medicare claims will not be denied or audited solely based on the specificity of diagnoses codes as long as they still come from the appropriate family of ICD-10 codes.
2. Similarly, physicians will not face penalties for the Physician Quality Reporting System based on the specificity of diagnoses codes as long as the code is from the correct ICD-10 family of codes.
3. CMS will authorize advance payments to physicians if Medicare contractors are unable to process claims due to ICD-10-related issues.
4. CMS plans to establish a communication center to monitor and resolve issues, including an appointed official to investigate physician complaints.
It is important to note that Medicare claims processing systems will not be able to accept ICD-9 codes for services after Sept. 30, 2015. This includes dual ICD-9 and ICD-10 coding.
CMS has also released "Road to 10," a guidance geared toward smaller physician practices to help them continue their transition.
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