June 30, 2015

CMS Responds to AMA/Specialty Society ICD-10 Concerns

The Centers for Medicare & Medicaid Services (CMS) has laid out its plans to mitigate potential adverse effects of International Classification of Disease Version 10 (ICD-10) identified in a March 4 letter from the American Medical Association (AMA) and co-signed by the American College of Radiology and other health organizations.

The May 8 written response from CMS Acting Administrator Andrew M. Slavitt to AMA CEO James L. Madara described the agency’s strategy for a smooth transition before and after ICD-10’s October 1 implementation. Slavitt thanked the AMA and specialty societies for sharing their concerns and provided a list of what CMS plans to do to mitigate any adverse effects.

As described on the CMS ICD-10 webpage, the agency has collaborated with physicians and other industry stakeholders to create tailored training, resources and tools specifically for physician and staff preparation. CMS is hosting national weekly implementation meetings with provider groups, industry stakeholders, clearinghouses, vendors and commercial payers. It has expanded free learning opportunities through national provider calls and webinars, training videos, testing, and resources, such as the CMS website and Road-to-10 tool, Slavitt wrote.

Pre- and post-implementation physician support will be available from added call center support through its Medicare Administrative Contractors (MACs). In addition, CMS, the Workgroup for Electronic Data Interchanged (WEDI), the AMA, the American Hospital Association, and other industry leaders and partners, have launched the “ICD-10 Implementation Success Initiative.” Its first phase features a searchable online database enabling users to report and receive advice about of ICD-10 implementation issues. The database will be updated frequently with information and resources to help with pre- and post-implementation questions.

CMS website tools include:

  • National Coverage Determinations converted from ICD-9 to ICD-10
  • Medicare Severity-Diagnostics Related Groups converted from the Current ICD-9 version to an ICD-10-CM
  • Pilot version of the October 2014 Integrated Outpatient Code Editor utilizing ICD-10-CM
  • Local coverage determinations consolidated in the LCD database 

In response to the AMA and specialty society concern about possible cash flow interruptions, CMS may determine circumstances that warrant the issuance of advance payments to all affected suppliers furnishing Part B services. Specific physician or supplier requests will not be required to help diminish the impact of implementation problems. This authority applies only when CMS systems are unable to process valid Medicare Part B claims that contain ICD-10 codes.

CMS offers the following options for providers who cannot submit claims with ICD-10 diagnosis codes due to problems with the provider’s systems:

  • Free billing software that can be downloaded at any time from every MAC
  • In about half of the MAC jurisdictions, claims submission functionality on the MAC’s
    provider internet portal, and
  • Submitting paper claims, if the requirements of section 1862(h) are met.  

See the May 8 CMS response for more details and refer to the ACR ICD-10 resources page for the latest information from CMS and other sources.