Submitted on Tue, 2015-09-08
By SMART Health Claims

CMS Announces ICD-10 Claims Will Not Be Denied for 12 Months

In a surprise July announcement, The Centers for Medicare & Medicaid Services (CMS) announced that it will not deny incorrect ICD-10 claims for one year following the October 1, 2015 deadline. The announcement halts speculation that the deadline will be further delayed, calming industry-wide anxiety with a 12-month safety net to prevent penalties for claim submission errors.

"While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family"
- Centers for Medicare & Medicaid Services

Renewed Optimism for a Complex Transition

For Public Health Agencies, the announcement eases uncertainties and fears about transition. The grace period provides LHDs an entire year to organize their administrative processes and perfect their systems without risk to their billing revenue.

“It creates a buffer so that if you’re not perfect, you still get paid. If you have a system problem or administrative problem tied to ICD-10, they are allowing prepayment requests and authenticating after the fact, giving some relief.”
Amy Amick, MedAssets

Encouragingly, some experts believe the “doomsday” label ICD-10 has earned may not be accurate. While large insurance companies and hospital systems are dealing with large-scale changes, smaller practices will not be as overwhelmed. Jim Daley, director of IT at BlueCross BlueShield of South Carolina said, "Practices will not need to know all of the 68,000 codes in ICD-10. Depending on the office, they may use a few dozen codes. Some may go beyond that, but it is not going to be 68,000."

For LHDs, the anticipation may be worse than the reality, as expert insight implies that the new system will be easier than they assume. Even if mistakes are made, there are no financial consequences for an entire year.

ICD-10 Homestretch: Your Checklist to Prepare

A June survey found that 21% of California physician practices are not ready for ICD-10. Astoundingly, 74% of providers had not even started their transition at all. To help prepare for the rapidly-approaching deadline, the American Hospital Association created an ICD-10 Homestretch Checklist with key final steps to ensuring a successful transition to ICD-10. Here are the highlights of the checklist:

✓ Check Internal Systems
Local health departments should start by verifying that all systems, applications, and software are ready for the transition. Additionally, they should conduct an evaluation of staff training and documentation improvement efforts to ensure not only that everyone working on ICD-10 is ready but that the tools necessary to support documentation are in place. The coding team should know to access ICD-10 coding guidelines and AHA Central Office advice at

✓ Verify External Partner Readiness
It is essential to ensure that all LHD partnerships with health plans are ready for ICD-10 and are equipped to communicate effectively between organizations. They must understand the rules and processes for submitting replacement claims in cases of error and have emergency contact information for Medicare contractors and commercial insurers on hand, in case claims are delayed. Also, LHDs must ensure they understand the steps needed to limit delays in payment from trading partners.

✓ Consider Financial Protections
LHDs should establish metrics that track current claims volume along with associated monetary amounts to create a baseline for tracking future claims volume submitted and processed. Beginning Oct. 1, they should monitor the status of submitted claims (often available through health plan web portals) to learn whether problems are occurring, so they do not turn into financial hardships. CMS has procedures that providers can follow for payment advances from Medicare in the event of financial difficulties due to lag in Medicare billing and/or payments, available here.

Call Us Today If You're Not Ready

If your organization is unprepared for the transition to ICD-10, you cannot afford to wait. Schedule a meeting or call our team of public health ICD-10 experts at (800) 777-6092 TODAY to help you become ICD-10 compliant and see what options you have to continue billing following the October 1st deadline. 

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