CMS Administrator Slavitt Writes ICD-10 Letter to Providers

July 15, 2015 - The Centers for Medicare & Medicaid Services (CMS) released a letter today addressed to Medicare providers about ICD-10. According to CMS Acting Administrator Andrew M. Slavitt, the healthcare industry and greater community will thrive in a spirit of cooperation as the upcoming ICD-10 implementation deadline this October approaches.

Says Slavitt, there is still time to get ready and a plethora of available resources available to do so. “If you don' t use a valid ICD-10 code starting on October I, 2015, you will not be able to successfully bill for your services,” he confirms, calling ICD-9 “outdated” and “obsolete.”

“Starting on October 1, Medicare claims with a date of service on or after October 1, 201 5 will only be accepted if they contain a valid ICD-10 code. The Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of service after September 30, 2015 or accept claims that contain both ICD-9 and ICD-10 codes,” Slavitt explains.

As RevCycleIntelligence.com reported, Slavitt says he has directed CMS to release guidance to allow for flexibility in claims auditing and quality reporting processes:

• For 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a code from the right family. However, a valid ICD-10 code will be required on all claims starting on October 1, 2015.
• For all quality reporting completed for program year 2015, Medicare clinical quality data review contractors will not subject physicians or other Eligible Professionals (EP) to the Physician Quality Reporting System (PQRS), Value Based Modifier (VBM), or Meaningful Use (MU) penalties during primary source verification or auditing related to the additional specificity of the ICD-I0 diagnosis code, as long as the physician/EP used a code from the correct family of codes. Furthermore, an EP will not be subjected to a penalty if CMS experiences difficulty calculating the quality scores for PQRS, VBM, or MU due to the transition to lCD-I0 codes.
• CMS will not deny any informal review request based on 2015 quality measures if it is found that the EP submitted the requisite number/type of measures and appropriate domains on the specified number/percentage of patients if the EP's only error(s) is/are related to the specificity of the lCD-10 diagnosis code (as long as the physician/EP used a code from the correct family of codes).
• CMS will set up a communication and collaboration center for monitoring the implementation of ICD-I0. This center will quickly identify and initiate resolution of issues that arise as a result of the transition to lCD-I0.
• CMS will name an ICD-10 Ombudsman to help receive and triage physician and provider issues.

Slavitt confirms upcoming ICD-10 implementation will essentially set the stage for advanced patient care and public health surveillance. Resultantly, the identification of illness will be strengthened. Earlier warning signs when epidemics and pandemics, such as Ebola, break out will allow for a more effective healthcare system, he says. A needed refashioning of the nation’s healthcare skeleton means that as time passes, coordination of a patient’s care across various providers will improve.

ICD-10 will also manifest additional advances in public health research and emergency response by better disease detection and adverse drug events, he says. Innovative payment models that promote quality care and enhance fraud detection efforts will also prove heavily beneficial to the collective healthcare landscape, Slavitt says.

Slavitt additionally references a variety of resources CMS has made available to enhance ICD-10 preparation. “We understand that moving to ICD-10 is a significant change, and CMS wants providers to be successful. In response to requests from the provider community, I directed CMS to release guidance that allows for additional flexibility in the claims auditing and quality reporting processes,” he adds.