CMS and AMA Initiatives Will Help Providers Prepare for ICD-10

 

July 6, 2015—The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) announced efforts to continue to help physicians get ready ahead of the October 1 deadline when the nation switches its International Classification of Diseases (ICD) coding for medical diagnoses and inpatient hospital procedures from ICD-9 to ICD-10. The change is required for everyone covered by HIPAA, the Health Insurance Portability Accountability Act.

CMS advised that the Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of services after September 30, 2015, nor will they be able to accept claims for both ICD-9 and ICD-10 codes.

The announcement noted that the ICD medical codes used in the United States for diagnosis and billing have not been updated in more than 35 years and contain outdated, obsolete terms. 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, stated CMS and AMA.

In response to requests from the provider community, CMS is releasing additional guidance to allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD-10 code set.

CMS and AMA stated that they recognize that health care providers need help with the transition, and the organizations are reaching out to health care providers across the country. CMS and AMA will be educating providers through webinars, on-site training, educational articles, and national provider calls to help physicians and other health care providers learn about the updated codes and prepare for the transition.

CMS is offering free help that includes the “Road to 10" website at www.roadto10.org, which is aimed specifically at smaller physician practices with primers for clinical documentation, clinical scenarios, and other specialty-specific resources to help with implementation. CMS has also released provider training videos that offer helpful ICD-10 implementation tips.

Information about the AMA’s range of materials to help physicians prepare for the October 1 deadline is available on AMA Wire at www.ama-assn.org/ama/ama-wire/blog/ICD-10/1.

CMS also detailed its operating plans for the ICD-10 implementation, including:

  • Setting up an ICD-10 communications and coordination center, learning from best practices of other large technology implementations that will be in place to identify and resolve issues arising from the ICD-10 transition.
  • Sending a letter in July to all Medicare fee-for-service providers encouraging ICD-10 readiness and notifying them of these flexibilities.
  • Completing the final window of Medicare end-to-end testing for providers this July.
  • Offering ongoing Medicare acknowledgement testing for providers through September 30th.
  • Providing additional in-person training through the “Road to 10” for small physician practices.
  • Hosting an MLN Connects National Provider Call on August 27th.

Also, at the request of the AMA, CMS will name a CMS ICD-10 Ombudsman to triage and answer questions about the submission of claims. The ICD-10 Ombudsman will be located at CMS’s ICD-10 Coordination Center.

 

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