Wednesday, January 16, 2019

RCMA/CMA Works with CMS to Mitigate Medicare ICD-10 Disruptions

With implementation of the ICD-10 code set just around the corner, many physicians have been understandably wary about the transition and the potential for payment disruptions and claims processing errors that could interfere with patient care. Fortunately, the RCMA/CMA – working closely with the American Medical Association (AMA) and other medical associations – has secured provisions that will ease this transition, particularly for physicians in practices with limited resources.

Thanks to RCMA/CMA advocacy, the Centers for Medicare & Medicaid Services (CMS) recently announced that it will provide a one-year grace period during which it will allow for flexibility in the Medicare claims payment, auditing and quality reporting processes as the medical community gains experience using the new ICD-10 code set. The ICD-10 implementation date of October 1, 2015, has not changed.

The changes announced include: Claim denials: Medicare review contractors will not deny claims based solely on the specificity of the ICD-10 diagnosis code as long as a valid code from the right family of codes is used. Moreover, physicians will not be subject to audits as a result of ICD-10 coding mistakes during the grace period.

Quality reporting: Physicians also will not be penalized under the quality reporting programs for errors related to the additional specificity of the ICD-10 diagnosis code, again as long as a code from the correct family of codes is used.

Advance payments: If Medicare contractors are unable to process claims within established time limits because of administrative problems, such as contractor system malfunction or implementation problems, advance payment may be available to keep resources flowing to physician practices.

ICD-10 communication center: CMS will set up a communication center to monitor the implementation of ICD-10 in an effort to quickly identify and resolve issues related to the transition. As part of the center, CMS will have an ICD-10 ombudsman to help receive and triage physician and provider issues.

Understanding The Covered CA Grace Period

RCMA/CMA has made significant progress through our advocacy efforts to help ensure that physicians are not on the hook for unpaid claims in months two and three of the three month grace period. Instead, coverage will be suspended during those two months. We have prepared an easy to understand fact sheet to help physicians and their staff understand what the grace period means for their practices and their patients.

Download  Understanding the Grace Period for Subsidized Exchange Enrollees FAQ Sheet


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