CMS releases FAQ with details on a grace period for denied claims after the Oct. 1 deadline
CMS and the American Medical Association (AMA) released a set of measures to help physicians with the transition to ICD-10. CMS plans to have a year grace period during which it will reimburse physicians under Medicare Part B for claims with incorrect ICD-10 diagnosis codes. To qualify, the claims must have a valid ICD-10 diagnosis code within the same family as the correct code.
From the CMS FAQ:
Q. What happens if I use the wrong ICD-10 code, will my claim be denied?
A. 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. However, a valid ICD-10 code will be required on all claims starting on October 1, 2015. It is possible a claim could be chosen for review for reasons other than the specificity of the ICD-10 code and the claim would continue to be reviewed for these reasons. This policy will be adopted by the Medicare Administrative Contractors, the Recovery Audit Contractors, the Zone Program Integrity Contractors, and the Supplemental Medical Review Contractor.
PracticeAdmin is ICD-10 ready. GEMs (General Equivalence Mappings), which were developed by CMS to provide a map or crosswalk between ICD-9 and ICD-10, have been incorporated directly into version 6.7 of ProviderSuite.
Visit the CMS site to read the complete FAQ.
Q. What happens if I use the wrong ICD-10 code, will my claim be denied?
A. 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. However, a valid ICD-10 code will be required on all claims starting on October 1, 2015. It is possible a claim could be chosen for review for reasons other than the specificity of the ICD-10 code and the claim would continue to be reviewed for these reasons. This policy will be adopted by the Medicare Administrative Contractors, the Recovery Audit Contractors, the Zone Program Integrity Contractors, and the Supplemental Medical Review Contractor.
