Countdown to the October 1, 2015
ICD-10 Compliance Date
ICD-10 Compliance Date
ICD-9 to ICD-10 (“Grace Period” Announced from the AMA and CMS )
The AMA and CMS have announced an agreement on important elements of a “grace period” for the October 1, 2015, ICD-10 implementation. Additional information and guidance will be issued from CMS.
The medical community reached out to the House of Representatives and Senate to request Congress work with CMS to mitigate the potential impacts of the transition to ICD-10 by establishing a “grace period” during which physicians will not be penalized for errors, mistakes and or malfunctions related to adjusting to new ICD-10 coding specifications.
The “grace period” will include:
- For a one year period starting October 1, Medicare claims will not be denied solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes. In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes. This policy will be followed by Medicare Administrative Contractors and Recovery Audit Contractors.
- To avoid potential problems with mid-year coding changes in CMS quality programs (PQRS, VBM and MU) for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores (i.e., for PQRS, VBM, or Meaningful Use). CMS will continue to monitor implementation and adjust the duration if needed.
- CMS will establish an ICD-10 Ombudsman to help receive and triage physician and provider problems that need to be resolved during the transition.
- CMS will authorize advanced payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation.
- Claims submitted for end-to-end testing process also will be subject to all National Coverage Determinations and Local Coverage Determinations.
More than an update, a leap in how we define care.
Modern History of the Medical Dictionary—ICD-10
The World Health Organization’s (WHO) International Classification of Diseases has served the healthcare community for over a century. The United States implemented the current version (ICD-9) in 1979. While most industrialized countries moved to ICD-10 several years ago, the United States is just now transitioning with a compliance transition start date of October 1, 2015. It’s time our Medical Dictionary reflected modern medicine.
By Physicians for Physicians
Under the sponsorship of the WHO, a select group of physicians created the basic ICD-10 structure. Following this, each physician specialty within the United States offered their input on the subset of diagnosis codes required. In most cases, the specialties advocated capturing additional detail based on information that physicians intuitively use in delivering patient care.
These changes enhance current medical documentation standards to capture a greater level of detail in patient care. Accurate analysis of health data will help improve the quality and efficiency of delivering patient care, particularly as electronic sharing and exchange of health records grows.
The ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets beginning on October 1, 2015. ICD-10 consists of two parts:
- ICD-10-CM diagnosis coding which is for use in all U.S. health care settings.
- ICD-10-PCS inpatient procedure coding which is for use in U.S. hospital settings.
- Claims for services provided on or after the compliance date should be submitted with ICD-10 diagnosis codes.
- Claims for services provided prior to the compliance date should be submitted with ICD-9 diagnosis codes.
How will my practice benefit from ICD-10?
Prepping for the compliance date is critical
ICD-10 will provide an enhanced platform for physician practice. As of October 1, 2015, the ICD-10 coding classification will start to become the new baseline for clinical data, clinical documentation, claims processing, and public health reporting. Understanding patient encounters and preparing for the transition will be critical to the financial sustainability of each practice.
From proper observation and documentation to improved clinical documentation, progress notes, operative reports, and histories, the benefits of ICD-10 begin with enhanced clinical documentation enabling physicians to better capture patient visit details and lead to better care coordination and health outcomes.
Ultimately, better data paves the way for enhanced quality and greater effectiveness of patient care and safety. While the transition to ICD-10 will require work, it is temporary. The benefits of ICD-10 will impact everything from patient care to each practice’s bottom line.
The following is a list of important questions to address now to help you prepare your practice for ICD-10.
1. Will you be able to submit claims?
2. Will you be able to complete medical records?
3. How will you code your claims under ICD-10?
4. Where do you use ICD-9 codes? Is there anywhere you use ICD-9 codes other than claims submission or your EHR?
5. Are there ways to make coding more efficient?
For more information, please call us at 225.300.1292 or contact an AOS Medical ™ representative to try it.
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