ICD-10: Physicians asked for a two-year ICD-10 grace period—CMS delivers one
“With less than four months to go before the deadline for implementing the ICD-10 code set, physicians Monday agreed to seek a two-year grace period for physicians to avoid financial penalties to facilitate a smoother transition that would allow physicians to continue providing quality care to their patients without disruption.”
That’s the opening paragraph from a June 2015 AMA Wire® piece outlining how doctors attending the 2015 AMA Annual Meeting voted to collectively call upon the Centers for Medicare & Medicaid Services (CMS) to “wave penalties for errors, mistakes or malfunctions in the system” for two years after the new code set’s implementation.
The AMA’s contention had been that physicians would be overwhelmed with the 400 percent increase in the number of codes used for diagnosis, which would, according to AMA’s Russell W.H. Kridel, MD, a member of the AMA Board of Trustees, “take time away from the valuable one-on-one patient-physician interface that is the hallmark of taking the best care of patients. We continue to press both Congress and the administration to take necessary steps to avoid widespread disruption to physician practices created by this overly complex and burdensome mandate.”
The AMA’s request had not been the only one, as HealthDataManagement reported in its June 10 online article, House Bill Seeks ICD-10 Grace Period. The piece revealed how Rep. Gary Palmer of Alabama had “sponsored the ‘Protecting Patients and Physicians Against Coding Act’ (J.R. 2652), which calls for a two-year grace period so that providers ‘can focus on patient care instead of coding and receiving compensation for their care while ICD-10 is being fully implemented.”
Representative Palmer argued that having to learn the multitude of new ICD-10 codes would especially place small town providers at risk, as they would be less able than their urban counterparts to financially withstand delayed or denied payments due to incorrect coding.
The HDM article also highlighted similar legislation introduced by Tennessee Rep. Diane Black, in which she attempted to “institute an 18-month transition period beginning October 1, during which no claim submitted for payment by a provider would be denied as a result of using an unspecified or inaccurate code.”
As is evidenced by the recent announcement, CMS listened. As Medscape.com reported recently:
In a joint announcement with the AMA, CMS yesterday said that claims would not be rejected solely on the basis of code specificity. They will pass muster as long as the code submitted is in the correct ICD-10 family…Besides going easy on claims processing, CMS said it will not penalize physicians if they submit data that contain less than perfect ICD-10 codes to Medicare quality programs in 2015 such as the Physician Quality Reporting System. Again, as long as physicians use a code from the correct ICD-10 family, they need not fear a pay cut for a minor mistake.
The article went on to quote AMA President Steven Stack, MD, who called these and other ICD-10 concessions "a culmination of vigorous efforts to convince the agency of the need for a transition period to avoid financial disruptions during this time of tremendous change."
Providers should perhaps not be too elated about these concessions, however, as MediRevv’s own coding expert, Kim Vegter, CPC, CPC-I, cautions:
It is encouraging that Medicare is willing to relax their policies (just a bit) on denials based on specificity, but providers should beware that this won’t be a free for all. The document specifically states that ‘review contractors will not deny…claims based solely on the specificity of the ICD-10 diagnosis code.’ This doesn’t mean Medicare won’t deny any claims. Providers should remain diligent about sending out clean claims and take advantage of every opportunity available to help prepare them before and after the transition.