Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

CMS, AMA Announce ICD-10 Deal to Avoid Financial Disruption

- The Centers for Medicare & Medicaid Centers (CMS) and the American Medical Association (AMA) announce their collective agreement today on ICD-10 efforts. The primary objective from both organizations is to circumvent possible upcoming financial disruptions following the upcoming October 1 ICD-10 implementation deadline during a time of pronounced change within the healthcare industry.

ICD-10 delay

According to the collective announcement, once September has ended, Medicare claims processing systems will lack the ability to accept ICD-9 codes for dates of services. Additionally, they will be unable to accept claims for both ICD-9 and ICD-10 codes.

According to Steven J. Stack, MD, AMA President, many physicians are apprehensive about adopting the ICD-10 code set come October due to a burdensome investment of time and resources in addition to expected holes in patient care stemming from heavy claim disruptions.

“AMA has secured provisions that will ease this transition, particularly for physicians in practices with limited resources,” Stack states. “In response to our extensive communication of physicians’ concerns, [CMS] announced today that it is making several critical changes to the transition period so that physicians can continue to provide high-quality patient care without risking their livelihood,” he adds.

In reference to specific issues of claim denials, quality reporting penalties, payment disruptions, and navigating transition problems, Stack says, “These provisions are a culmination of vigorous efforts to convince the agency of the need for a transition period to avoid financial disruptions during this time of tremendous change. These provisions are a testament to the power of organized medicine and what we can achieve when we band together for the good of our patients and our profession.” 

Stack maintains this collective voice will advance practice environments, enhance practice stability, and promote ongoing quality care across the healthcare industry. The AMA additionally asks CMS to decide upon a CMS ICD-10 Ombudsman, to be located at CMS's ICD-10 Coordination Center, to manage claim submission questions. 

“We appreciate that CMS is adopting policies to ease the transition to ICD-10 in response to physicians’ concerns that inadvertent coding errors or system glitches during the transition to ICD-10 may result in audits, claims denials, and penalties under various Medicare reporting programs," Stack maintains. "The actions CMS is initiating today can help to mitigate potential problems. We will continue to work with the administration in the weeks and months ahead to make sure the transition is as smooth as possible.” 

CMS has additionally commented on today's vital ICD-10 announcement. Says Andy Slavitt, Acting Administrator of CMS, “As we work to modernize our nation’s health care infrastructure, the coming implementation of ICD-10 will set the stage for better identification of illness and earlier warning signs of epidemics, such as Ebola or flu pandemics."

 

 

 

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