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No Medicare Claim Denials After ICD-10 Transition, Says CMS

By Jacqueline DiChiara

- ICD-10 implementation is now a horse of a different color. The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) are seeing eye-to-eye on matters of ICD-10 and claims denial. CMS has outlined 4 specific steps to make the transition to ICD-10 smoother.

icd-10 deadline

As RevCycleIntelligence.com reported, Andy Slavitt, Acting Administrator of CMS, and Steven J. Stack, MD, AMA President, have both commented on a significant healthcare announcement regarding the organizations’ confirmed collaborative efforts.

According to an AMA press release, CMS confirms it will make 4 specific crucial changes to the ICD-10 transition period so physicians can provide high quality care without jeopardizing their livelihood come October 1.

No Medicare claims denials in year 1

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  • Within the first year following ICD-10 implementation, Medicare claims will not be denied due to code specificity. As long as codes align with the appropriate family of ICD-10 codes, they will not be denied.

    Physician penalities dropped

    CMS has announced that as long as physicians use a code from the correct ICD-10 family of codes, they will not be subject to penalties for the Physician Quality Reporting System, the value-based payment modifier, or meaningful use. Such is based on the specificity of diagnosis codes, CMS confirms.

    Advance payments authorized

    CMS will authorize advance payments to physicians if Medicare contractors cannot process claims due to ICD-10-based hiccups.

    Transition problems will be addressed

    CMS will create a communication center to address ICD-10-based hitches and solve them expediently. An ICD-10 ombudsman will help resolve those pressing issues physicians may face come October.