07/15/2015

CMS Announces ICD-10 Flexibility on Denials

In an effort to address provider concerns, CMS has announced additional guidance to help with the transition. Along with educational webinars, on-site training and educational articles, CMS has announced that they will allow for flexibility in the claims auditing and quality reporting process. For a period of 12 months following the implementation of ICD-10, Medicare contractors will not deny physician claims billed under PART B schedule (through automated or complex medical record review) based solely on the specificity of the ICD-10 diagnosis code as long as the provider used a valid code from the right family. This policy will be adopted by the Medicare Administrative Contractors, the Recovery Audit Contractors, the Zone Program Integrity Contractors, and the Supplemental Medical Review Contractor. The same will apply to the diagnosis codes used for PQRS or MU reporting purposes; however, here again, the provider must use a diagnosis for the correct family of codes. For further information, please refer to the CMS link below: http://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/ICD10/