Earlier in July, CMS sent a letter out to Medicare providers. The letter was sent as a reminder that in order to successfully bill for services, ICD-10 codes must be used starting on Oct. 1, 2015. The Medicare claims processing system will not have the capability to accept ICD-9 codes for dates of service after September 30, 2015, and will not accept claims that contain both ICD-9 and ICD-10 codes.
CMS has provided the following guidelines to help ease the transition, and allows for additional flexibility in the claims and auditing quality reporting processes. These guidelines include:
- 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.
- 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-10 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 ICD-10 codes.
- CMS will not deny any informal review request based on the 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 ICD-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 ICD-I 0.
- CMS will name an ICD-1 0 Ombudsman to help receive and triage physician and provider issues.