Medicare To Be More Lenient With New Payment Coding System
by July 8, 2015 10:05 am 120 views
The federal Centers for Medicare and Medicaid Services won’t deny doctors’ wrongly coded Medicare claims in a new coding system for a year as long as the claims are in the right family of codes, the American Medical Association announced this week.
The federal government is requiring all medical providers to switch from the ICD-9 system to ICD-10 on Oct. 1. “ICD” stands for International Classification of Diseases.
In a statement on the AMA’s website, AMA President Steven J. Stack, M.D., said the announcement means that providers will be paid, won’t be audited, and won’t face penalties for a year if they make unintentional errors on specific codes as they transition from the ICD-9 to the ICD-10 coding system, as long as their submissions are in the correct family of codes. CMS also will authorize advance payments to physicians if Medicare contractors can’t process claims because of problems with ICD-10. A communication center, including an ICD-10 ombudsman, is being created to monitor and resolve issues.
ICD-9, which has been in use in the United States since 1979, categorizes all medical ailments and procedures into 13,000 codes. The ICD-10 system, which was endorsed by the World Health Organization in 1990, categorizes those procedures into 68,000 far more specific codes that detail the exact ailment (for example, which arm was broken) and its cause.
David Wroten, executive vice president of the Arkansas Medical Society, said in June that of the 95 clinics that had responded to a survey, only 16% said they were ready to implement ICD-10, and almost 30% did not believe they would be ready in October.
The announcement doesn’t change the fact that the state’s 38,000 Medicaid providers still must be prepared to make the switch by Oct. 1 in order to be paid, said Amy Webb, spokesperson for the Arkansas Department of Human Services.
“The announcement from CMS yesterday was specific to MEDICARE providers only,” she said in an email. “We’re talking with CMS about the announcement, but we want to make it clear to Medicaid providers that the deadline is still Oct. 1 to transition to the new system.”
Webb said the Medicare policy change will be discussed in a series of town halls DHS is having with medical providers starting this week.