CMS Issues ICD-10 Grace Period for Medicare Claims

Wouldn't you know it? The Center for Medicare & Medicaid Services just couldn't make it to Oct. 1 without messing with the parameters of ICD-10. But pediatricians take note: this latest twist to the impending transition of the new code set likely does not apply to most of you. This week, CMS announced a one year grace period for all Medicare (not Medicaid) claims that use the ICD-10 code set scheduled to go into effect Oct. 1. This means CMS will pay for all incorrect ICD-10 codes as long as the codes submitted are somewhat accurate.

From the language in CMS announcement, it appears pediatricians, who largely deal with Medicaid, would not be affected by the allowance. Medicaid is a jointly-funded Federal and state program and provides health insurance for about 44 million low-income people nationwide, including children. Medicare is federally managed and the payment rates are set by Congress.

Originally set for Oct. 1, 2013, the ICD-10 transition has been postponed twice. Both times, CMS caved in to fears among providers that a longer transition period was needed to avoid financial interruptions. And while this year's Oct. 1 deadline appears to be solid, this latest compromise shows the power physicians group lobbyists have on the proces

AMA President Dr. Steven Stack called the ICD-10 concessions “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,” Dr. Stack added.

PCC's Jan Blanchard, who is also a Certified Pediatric Coder, says she's waiting for the American Academy of Pediatrics to weigh in on whether the Academy thinks Medicaid should have been included in the provision.

Blanchard also hopes CMS uses the grace period as a time to coach physicians on choosing the correct ICD-10 codes.

More details on CMS's terms, as they apply to Medicare:

No ICD-10 Audits: Medicare claims will not be audited based on the accuracy of ICD-10 diagnosis codes as long as they are in the ballpark.

No Quality Reporting Penalties: Like the change to claim denials, CMS won't penalize physicians under the Physician Quality Reporting System, the value-based payment modifier, or the meaningful use program based on the specificity of diagnosis codes as long the codes are in the correct family.

Payment Disruptions: CMS will allow advance payments to physicians if Medicare carriers have trouble processing claims because of the transition.

More Communication: CMS will create a communications center to track problems during and after the run-up to October 1.


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