AMA on board with CMS plan to ease ICD-10 transition

The Centers for Medicare & Medicaid Services is introducing measures in conjunction with the American Medical Association to ease the transition to ICD-10 this fall.

In a post to AMA Viewpoints, AMA President Steven Stack elaborates on a joint announcement released Monday, saying that Medicare claims, for the first year of ICD-10 use, will not be denied or audited based solely on the specificity of diagnosis codes, as long as the codes on such claims are from the correct family of codes in the new code set. If Medicare contractors cannot process claims due to problems with ICD-10, he says, CMS will authorize advance payments to physicians.

"This means that Medicare will not deny payment for these unintentional errors as practices become accustomed to ICD-10 coding," Stack writes. Both Medicare Administrative Contractors and Recovery Audit Contractors must follow the policy, according to Stack.

Additionally, he notes, penalties for the Physician Quality Reporting System, the value-based payment modifier or Meaningful Use will not be levied based on code specificity as long as codes submitted are in the correct family. What's more, should CMS run into trouble calculating quality scores for the aforementioned programs based on ICD-10, penalties will not be applied.

An "ICD-10 ombudsman" employed by CMS will work to sort through such issues as they arise via a "Coordination Center," according to the agency.

"CMS is committed to working with the physician community to work though this transition," CMS Acting Administrator Andy Slavitt says in the announcement.

The announcement comes on the heels of CMS touting the results of its third round of ICD-10 acknowledgement testing. Claims from 90 percent of the more than 1,200 submitters who participated in testing week, from June 1-5, were accepted, the agency announced.

A survey unveiled by the eHealth Initiative last month showed that of 271 providers, half said they have conducted test transactions using ICD-10 codes with payers and clearinghouses. Only 34 percent said they have completed internal testing, while 17 percent have completed external testing.

What's more, the Workgroup for Electronic Data Interchange has warned that unless all industry segments move forward with implementation of ICD-10, "there will be significant disruption on Oct. 1, 2015."

At its annual meeting in Chicago last month, the AMA, at the behest of Alabama urologist William Jefferson Terry, called for a two-year grace period for the ICD-10 transition. Terry served as one of seven witnesses to testify at a hearing of the House Energy and Commerce Committee's Subcommittee on Health on ICD-10 in February, saying that a hasty "big bang" transition has potential to "do irreparable harm" to patients and physicians.

To learn more:
- here's the AMA/CMS announcement
- check out Stack's post