CMS Is Here to Help!

There are 79 more days till the ICD-10 switchover! Does it feel real yet? October 1, 2015, is rushing right up. Fortunately you are not the only one hoping for a smooth transition without painful claim denials and confusion. CMS is looking ahead and making preparations to help out. Recently CMS announced four key ways it intends to help:

1. Designating an Ombudsman

CMS anticipates questions and issues from many providers, so they are designating an official whose entire time will be devoted to investigating and resolving your problems as you adjust to ICD-10. Stay tuned for more information about how to submit issues to this ombudsman.

2. Leeway on Specificity

It can take a while to reach proficiency with any new system, so CMS is going to grant some leeway for the first twelve months: Your Medicare claims (under the Part B physician fee schedule) will NOT be denied because you used the wrong ICD-10 code - as long as you were close. Note that you could still be denied for something else, you still need to use a valid ICD-10 code, and you still need to use an ICD-10 code from the right family. However, this promise reassures you that as long as you are trying hard you will be given some grace for small mistakes.

3. Penalty Suspension

Similarly, for quality reporting for the year 2015 (i.e. Physician Quality Reporting System, Value Based Modifier, or Meaningful Use Stage 2), you will not receive penalties based on using an ICD-10 code that wasn't specific enough. The same caveats apply here: you do need to use a valid ICD-10 code from the correct family.

4.Advance Payments

If your claim is held up in processing because Medicare contractors are delayed by adjustment problems, you will be able to apply for an advance payment based on your claim. Again, stay tuned for more detail on how to do this when the time comes.

Thinking about all the areas this change to ICD-10 will affect can be a little daunting. However, whenever this gets you down, remember that CMS has options to make this easier for you.

Written by Laura Rowe