Federal CMS and AMA announce ICD-10 grace period

Thursday, July 09, 2015 10:43 AM

Colorado delegation to AMA was instrumental in formulating policy

The American Medical Association and Centers for Medicare and Medicaid Services (federal CMS) jointly announced on July 6, 2015, that agreement has been reached on important elements of a “grace period” for the Oct. 1, 2015, implementation of the ICD-10 diagnosis code set.

M. Ray Painter Jr., MD, the senior delegate of the CMS delegation to the AMA, formulated the concept and the CMS AMA Delegation took it to the AMA two years ago. Although the resolution passed and has been AMA policy since that time, it did not receive much attention because of the AMA’s hard-line stance on achieving
a delay of ICD-10 implementation, which they secured in 2014. Painter’s concept was re-introduced at the 2015 AMA Annual Meeting in June and showcased by the most vocal opponent to ICD-10, Jeff Terry, MD, of Alabama.

The federal CMS announced that:

• For a one year period starting Oct. 1, Medicare claims will not be denied solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes.  In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes. This policy will be followed by Medicare Administrative Contractors and Recovery Audit Contractors.
• To avoid potential problems with mid-year coding changes in CMS quality programs (PQRS, VBM and MU) for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores (i.e., for PQRS, VBM, or Meaningful Use). CMS will continue to monitor implementation and adjust the duration if needed.
• CMS will establish an ICD-10 Ombudsman to help receive and triage physician and provider problems that need to be resolved during the transition.
• CMS will authorize advanced payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation.

According to the AMA, the announcement demonstrates that the agency is responsive to physician concerns. The AMA will monitor and keep the agency apprised of any implementation issues that persist in 2016, and will urge the agency to make any needed adjustments to the grace period policy and timeline based on new information that surfaces during the implementation process.

The Oct. 1 deadline for implementation of the ICD-10 code set is fast approaching, and time is running out for physician practices to complete their preparation. The AMA has a broad range of materials available on its website  to help physicians prepare.