CHA News Article

CMS Announces Some Flexibility in First 12 Months of ICD-10 Audits

The Centers for Medicare & Medicaid Services (CMS) has issued the attached guidance announcing that physicians will not have their claims denied if they do not code to the correct level of specificity for the first 12 months of ICD-10 implementation, scheduled to begin on Oct. 1. Physicians 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.

CMS notes, however, that a valid ICD-10 code will be required on all claims beginning Oct. 1, and a claim could be chosen for review for reasons other than the specificity of the ICD-10 code. CMS also announced it will establish an ICD-10 monitoring center and ombudsman to 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.