OK! This CMS Agreement with AMA Helps Us "GO TO 10!"

Grace period agreement likely the death knell for another ICD-10 delay

July 8, 2015 | By Dan Bowman

In announcing a joint effort with the American Medical Association to ease the transition to ICD-10 for providers, the Centers for Medicare & Medicaid Services on Monday essentially sounded the death knell for the possibility of a fourth delay.

CMS said that, for the first year after the transition, it will not deny or audit Medicare claims from providers based solely on the specificity of diagnosis codes, as long as the codes on such claims are from the correct family in the new code set. What's more, if Medicare contractors cannot process claims due to problems with ICD-10, CMS will authorize advance payments to physicians.

Additionally, an ICD-10 ombudsman employed by CMS will work to sort through issues as they arise via a "Coordination Center," according to the agency.

While AMA wasn't the only organization opposed to the transition, it certainly was the most vocal. In May, it backed Rep. Ted Poe's proposal to eliminate ICD-10. And last November, then-AMA President Robert Wah joked that the association wanted to freeze ICD-10 in carbonite.

Now, AMA and CMS are seemingly locking arms and singing Kumbaya.

The plan offers a solution similar to legislation floated by Reps. Diane Black (R-Tenn.) and Gary Palmer (R-Ala.), who proposed grace periods of 18 months and two years, respectively. However, the key differentiator, according to American Health Information Management Association Senior Director of Coding Policy and Compliance Sue Bowman, is the requirement that codes stay within certain familial parameters. AHIMA opposed both Congress members' solutions, but offered support for the CMS-AMA collaborative effort, as did both Black and Palmer.

"The other proposals were too open ended," Bowman told FierceHealthIT. "We were concerned about the potential for wildly erroneous data and even fraud and abuse. The other proposals opened the door to say you could put any code on a claim and somehow expect to be paid with no questions asked."

Bowman said the new solution offers some flexibility for providers to learn the system and not have to worry about some of the specificity early on, while still requiring a basic level of accuracy.

"This got to the heart of what the physician community really wanted, which was not too much rigidity during the learning curve period," she said.

While pressure from the AMA and other groups no doubt loomed large, Bowman said the desire to ensure a smooth and successful transition likely was the biggest factor in CMS' decision to move forward with the grace period.

Whatever the case, she hopes that now people will have less anxiety, and will focus more on getting ready for the compliance state.

With AMA, CMS and AHIMA all on the same page, that's probably a safe bet. - Dan (@Dan_Bowman and @FierceHealthIT)