Medicare announces initial claims auditing/quality reporting flexibility for ICD-10

For 12 months after ICD-10 implementation, physicians and other practitioners who bill Medicare under the Part B physician fee schedule will not have claims denied by Medicare review contractors based solely on the specificity of the ICD-10 code if they use a valid ICD-10 code from the correct family of codes, the Centers for Medicare & Medicaid Services announced today. They also will not be subject to the Physician Quality Reporting System, Value Based Modifier, or Meaningful Use penalty for program year 2015 during primary source verification or auditing related to the additional specificity of the ICD-10 diagnosis code, the agency said. In addition, CMS said it will establish an ICD-10 monitoring center and ombudsman to will work with its regional offices to address physicians’ concerns, and allow Medicare physicians and suppliers to apply for an advance payment if Part B contractors are unable to process claims within established time limits. CMS and the American Medical Association announced the guidance as part of their efforts to help physicians prepare for ICD-10. Health care claims must include ICD-10 codes for medical diagnoses and inpatient hospital procedures beginning Oct. 1. For more on the transition to ICD-10, visit www.aha.org or www.cms.gov.