ICD-10 – How far we’ve come!

It’s still a surprise to me that we are actually here. It’s coming up to the end of July 2015 and we are closer to ICD-10 Go Live than anytime before. I’ve heard of one organization regionally that is still surprised we got here and are scrambling to get their work done. Others have been working on this for a few years and have put in more efforts over the last 7-8 months to prepare for this event. Many physicians can’t believe that we have come this far and are now concerned that they don’t have the tools and training to be ready for ICD-10 go live. What will the world look like on October 1st, 2015?

There are some vendors that are keeping their customers guessing about remediation of the systems and have their remediation requests in a long queue. Have you increased the real estate on those reports and extracts that you publish? Have you tested your main EMR and have you established your plans for command center for the go live? Are your organizational priorities focused on ICD-10 and maybe one other initiative? These are the questions that operationally and in IT, that leaders are dealing with right now. If they are not, then they have to do some soul searching as to how did they get to this status.

Healthcare IT News reported recently that the Centers for Medicare & Medicaid Services announced that it would work with the AMA on steps to ease the move to ICD-10 and that CMS will adopt suggestions made by the AMA with regard to the code set conversion. Those changes cover i) Claim Denials  ii) Quality Reporting and other penalties iii) Payment disruptions and iv) Navigating transition problems where CMS will create a communication or command center as well as a Tsar of ICD-10 to assist and triage provider related issues or concerns and be able to resolve issues caused by the new code sets.

Below are the points directly from Healthcare IT News:

1. Claims denials. “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,” CMS officials wrote in a guidance document.

2. Quality reporting and other penalties. “For all quality reporting completed for program year 2015 Medicare clinical quality data review contractors will not subject physicians or other Eligible Professionals (EP) to the Physician Quality Reporting System (PQRS), Value Based Modifier (VBM), or Meaningful Use 2 (MU) penalty during primary source verification or auditing related to the additional specificity of the ICD-10 diagnosis code, as long as the physician/EP used a code from the correct family of codes,” CMS explained. “Furthermore, an EP will not be subjected to a penalty if CMS experiences difficulty calculating the quality scores for PQRS, VBM, or MU due to the transition to ICD-10 codes.”

3. Payment disruptions. “If Medicare contractors are unable to process claims as a result of problems with ICD-10, CMS will authorize advance payments to physicians,” AMA president Steven Stack, MD, noted in a viewpoint piece on the group’s website.

4. Navigating transition problems. CMS intends to create a communication center of sorts, including an ICD-10 Ombudsman, “to help receive and triage physician and provider issues.” The center will also “identify and initiate”resolution of issues caused by the new code sets, officials added.

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