CMS, AMA Announce Plan To Ease Transition to ICD-10 Code Sets

July 7, 2015 in News

On Monday, CMS and the American Medical Association announced a set of measures designed to help ease physicians’ transition to the new ICD-10 code sets, FierceHealthIT reports (Bowman [1], FierceHealthIT, 7/6).

U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures by Oct. 1.

Details of the Measures

Under the new measures, CMS said it plans to establish a one-year grace period in which it will reimburse physicians under Medicare Part B for claims with incorrect ICD-10 diagnosis codes. In order to qualify, the claims must have a valid ICD-10 diagnosis code, which falls generally in the same family as the correct code.

In addition, CMS said it might authorize advanced payments to doctors if Medicare Part B contractors cannot process claims due to administrative problems within a set timeframe (CMS guidance, 7/6).

CMS also said it will extend the flexibility for quality code errors to the Physician Quality Reporting System, Value-Based Payment Modifier program and meaningful use program so physicians and other eligible professionals are not penalized (Goedert, Health Data Management, 7/6). The flexibility will apply to all quality reporting during program year 2015 (CMS guidance, 7/6).    

In concert with AMA, CMS plans to provide a range of online resources — including Web conferences and training documents — to aid providers in the transition. The agency also will appoint an ICD-10 ombudsman to help oversee the transition.


Prior to AMA’s partnership with CMS, the organization earlier this year supported legislation (HR 2126) to bar HHS from implementing the ICD-10 transition, Modern Healthcare reports.

AMA President Steven Stack says, “ICD-10 implementation is set to begin on Oct. 1, and it is imperative that physician practices take steps beforehand to be ready” (Dickson, Modern Healthcare, 7/6).

CMS acting Administrator Andy Slavitt says that “CMS is committed to working with the physician community” to manage the transition (Bowman [1], FierceHealthIT, 7/6). He added, “The coming implementation of ICD-10 will set the stage for better identification of illness and earlier warning signs of epidemics, such as Ebola or flu pandemics” (Modern Healthcare, 7/6).

CMS: 90% of Claims Accepted in Third End-to-End Testing Round

In related news, CMS has announced that 90% of claims were accepted in CMS’ third week-long ICD-10 end-to-end testing period, FierceHealthIT reports (Bowman [2], FierceHealthIT, 7/6).

The testing periods are designed for providers to determine whether ICD-10 codes submitted to Medicare will be accepted by the program (iHealthBeat, 6/2).

The latest round of testing involved about 13,000 claims submitted from June 1 to June 5 by more than 1,200 participants (Bowman [2], FierceHealthIT, 7/6).

Of all the participants that submitted claims:

  • 46% were specialty providers;
  • 14% were general hospitals;
  • 6% were primary care providers; and
  • 3% were critical access hospitals.

The June testing results show an increase in the claim acceptance rate compared with earlier rounds of testing, Health IT Analytics reports. For example, the previous two testing rounds showed acceptance rates of:

  • 88% in April; and
  • 81% in January.

According to CMS, most rejected claims were the result of testing development issues unrelated to ICD-10. CMS said, “Most rejects were the result of provider submission errors in the testing environment that would not occur when actual claims are submitted for processing” (Bresnick, Health IT Analytics, 7/6).

Specifically, errors in the latest round of testing — as in previous rounds — were related to:

  • Future service dates;
  • Invalid Healthcare Common Procedure Coding System code;
  • Invalid National Provider Identifier;
  • Invalid beneficiary number; and
  • Invalid or missing postal ZIP code (CMS release, June 2015).

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