HMC Helps Prepare You and Your Staff For ICD-10 (Sept. 2015)

by Belinda Holmes, BS, CPC, CCP-P 

AMA & CMS Highlights on ICD-10 Implementation

“ICD-10 implementation is set to begin on Oct. 1, and it is imperative that physician practices take steps beforehand to be ready,” Dr. Steven Stack, AMA’s president, said in a statement. The Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of services after Sept. 30, 2015, nor will they be able to accept claims for both ICD-9 and ICD-10 codes.

In July, with less than three months remaining until the nation switches from ICD-9 to ICD-10 coding, the CMS and the AMA announced a joint effort to help physicians get ready ahead of the October 1 deadline. In response to requests from the provider community, CMS is allowing for some flexibility in the claims submission and quality reporting process as the medical community gains experience using the new ICD-10 code set.

CMS is implementing the following concessions for ICD-10:

  • Claims: Beginning Oct 1, 2015 all claims will need to be submitted with ICD-10 codes.  However, Medicare claims will not be denied solely based on the specificity of the diagnosis codes as long as they are from the appropriate family of ICD-10 codes.
  • Incentive Programs: CMS will not subject physicians to penalties for PQRS, VBM, or MU based on the specificity of diagnosis codes as long as they use a code from the correct ICD-10 family of codes.
  • Payment: If Medicare contractors are unable to process claims as a result of problems with ICD-10, CMS will authorize advance payments to physicians.
  • Trouble shooting: CMS to establish a communication center to monitor and resolve issues including an “ICD-10 ombudsman” devoted to triaging physician issues.

If you need training or assistance with ICD-10 Implementation, please contact HMC at 941-922-3891.  We offer customized ICD-10 training sessions for physicians and coders with a focus on clinical documentation and coding; as well as, staff training with a focus on the revenue cycle impact that details payment, testing and vendor processes.