One Year “Grace Period” For ICD-10

ICD-10 Launch Button Cartoon

The ICD-10 implementation date has not been extended, but there is now a one-year “grace period”.

Although the impending date for ICD-10 has not been delayed, CMS announced this month that they will be extending a one-year “grace period” to help protect provider’s income and ease the transition to ICD-10. As we have worked with practices to put the proper tools in place to prepare for ICD-10 there seems to be a common concern regarding whether or not reimbursements for claims will be disrupted, or claims denied as they learn how to properly code in ICD-10.

This announcement from CMS should be welcome news for providers that share this concern.

Here are some of the highlights of the announcement:

  • Claims with Non-Specific codes will still be paid.

    • The primary reason the code set has expanded so drastically under ICD-10 is because of the level of specificity it provides. During the one-year grace period Medicare will not be denying claims for non-specific codes as long as the code submitted is in the same code family.
  • Use of Non-Specific codes for Quality Reporting will be acceptable.

    • Physicians will not be penalized based on the specificity of the code as long as the code used is from the same family of codes. This rule applies to PQRS, the EHR Incentive Program (Meaningful Use), and the value-based payment modifier.
  • Reimbursement for Medicare claims will not be withheld due to claims processing issues on their end.

    • CMS will authorize a payment advance if a Medicare contractor is unable to process a claim due to issues related to ICD-10.
  • Resources will be made available to help monitor and resolve ICD-10 related issues quickly.

    • CMS will establish a communication center that will included an ICD-10 ombudsman devoted to training physician issues.

CMS made a point of noting in the announcement that the Medicare claims processing system will not have the capability of accepting ICD-9 codes for dates of service after September 30, 2015. Providers need to continue to prepare for the impending October 1, 2015 transition deadline.

If you have not upgraded to an ICD-10 supported version of Medisoft or Lytec yet, please call ASAP so we can help you out. Contact us at (888) 799-4777.

For more information, please click here to visit the CMS website. Or you can read this post by AMA Wire.