Reposted from HealthData Management – August 4, 2015 by Joseph Goedert
CMS and AMA recently developed guidance on new ICD-10 flexibility for physicians during the first year of compliance. Now, at the request of stakeholders who found errors, CMS has substantially changed the guidance in Questions 3 and 5.
Below is background on policy changes that necessitated the guidance.
Under pressure from the AMA and other provider organizations, CMS agreed to:
- Not deny claims solely based on the specificity of diagnosis codes as long as they are in the appropriate family of codes, so physicians won’t be penalized because of a coding error
- Not audit Medicare claims in the first year of ICD-10 based on specificity of diagnosis codes if in the appropriate family of codes
- Authorize advance payments if Medicare contractors cannot process physician claims coded with ICD-10
- Not penalize physicians via reduced reimbursements for errors in selecting and calculating quality codes for the EHR meaningful use, PQRS and Value-based Modifier reporting programs as long as they use codes within the appropriate family of codes. Penalties also will not be applied if CMS has difficulty calculating quality scores during the ICD-10 transition
- CMS will establish an ICD-10 Ombudsman office to help physicians resolve problems during the transition.
Now, the agreement is significantly clarified with 13 specific questions and answers, including the changed guidance for Questions 3 and 5. Click here to review these questions.