MOST OF THE POPULATION may proceed beyond October 1 completely unaware of major changes in the coding system used for medical billing purposes.
But for those in the medical field, it would likely be difficult to transition painlessly without lots of good information to make things run more smoothly. With a switch from ICD-9 to ICD-10 looming on the horizon, the American Medical Association (AMA) recently announced changes designed to ease the pain of change somewhat. Here are highlights of the changes:
• Medicare claims will not be denied solely based on the specificity of the diagnosis codes as long as they are from the appropriate family of ICD-10 codes for the first year ICD-10 is in effect. Medicare will not deny payment for these unintentional errors as practices become accustomed to ICD-10 coding. Medicare claims also will not be audited based on the specificity of the diagnosis codes — as long as they are from the appropriate family of codes. The transition period will give physicians and their practice’s team time to get up to speed on the more complicated code set. Both Medicare Administrative Contractors and Recovery Audit Contractors will be required to follow this policy.
• CMS will not subject physicians to penalties based on the specificity of diagnosis codes as long as they use a code from the correct ICD-10 family of codes. And penalties will not be applied if CMS has difficulty calculating quality scores for these programs as a result of ICD- 10 implementation.
• If Medicare contractors are unable to process claims as a result of problems with ICD-10, CMS will authorize advance payments to physicians.
• CMS will set up a communication center to monitor and resolve issues — and include an “ICD-10 ombudsman” devoted to triaging physician issues.
While the changes may bring confusion and angst to various factions of the healthcare industry, on one point everyone seems to be in agreement: most will need assistance to get through this period. And there’s no shortage of resources available. “As we work to modernize our nation’s healthcare infrastructure, the coming implementation of ICD-10 will set the stage for better identification of illness and earlier warning signs of epidemics, such as Ebola or flu pandemics,” says Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services (CMS). “With easy-to-use-tools, a new ICD-10 Ombudsman, and added flexibility in our claims audit and quality reporting process, CMS is committed to working with the physician community to work through this transition.”
The medical codes America uses for diagnosis and billing have not been updated in more than 35 years and contain outdated, obsolete terms. The World Health Organization defines the International Classification of Diseases (ICD) as “the standard diagnostic tool for epidemiology, health management, and clinical purposes. This includes the analysis of the general health situation of population groups. It is used to monitor the incidence and prevalence of diseases and other health problems, proving a picture of the general health situation of countries and populations.”
A classification with such a wide impact can only be altered with a lot of planning and development of clear, understandable resources for those who will be most directly impacted. But make no mistake about it: the changes are coming.
“ICD-10 implementation is set to begin on October 1, and it is imperative that physician practices take steps beforehand to be ready,” says AMA President Steven J. Stack, MD. “We appreciate that CMS is adopting policies to ease the transition to ICD-10 in response to physicians’ concerns that inadvertent coding errors or system glitches during the transition to ICD-10 may result in audits, claims denials, and penalties under various Medicare reporting programs.
“The actions CMS is initiating today can help to mitigate potential problems. We will continue to work with the administration in the weeks and months ahead to make sure the transition is as smooth as possible,” he points out.
According to the CMS and the AMA, the use of ICD-10 should advance public health research and emergency response through detection of disease outbreaks and adverse drug events, as well as support innovative payment models that drive quality of care.
FOR ADDITIONAL INFORMATION:
• Centers for Medicate & Medicaid Services: Roadto10.org
• American Medical Association: http://ow.ly/RUeVz
article by MARY TOOTHMAN