Physicians will have a year to learn how to properly code under ICD-10 before facing potential penalties or withheld payments, according to a joint announcement from the Centers for Medicare & Medicaid Services and the American Medical Association.
During that first year using the new coding system, Medicare will not deny claims based solely on the specificity of diagnosis codes, provided they are in the appropriate family of ICD-10 codes. However, physicians still will not be able to use ICD-9 codes after Sept. 30, 2015.
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“This means that Medicare will not deny payment for these unintentional errors as practices become accustomed to ICD-10 coding,” Dr. Steven Stack, AMA president, wrote in a blog post on the AMA website. “This transition period will give physicians and their practice teams time to get up to speed on the more complicated code set.”
Similarly, physicians will not face penalties under the Physician Quality Reporting System, the value-based modifier, or the meaningful use program based on the specificity of diagnosis codes if the appropriate family of ICD-10 codes are used, according to the AMA. Finally, if a Medicare contractor is unable to process a claim due to coding issues, CMS will authorize an advance payment to the physician.
CMS also plans to create an ICD-10 coordination center and appoint an ombudsman to answer questions about claims submission using ICD-10.
“With easy-to-use tools, a new ICD-10 ombudsman, and added flexibility in our claims audit and quality reporting process, CMS is committed to working with the physician community to work through this transition.” Andy Slavitt, CMS Acting Administrator, said in a statement.