CMS and AMA Announces Flexibility Efforts to Help Providers with ICD-10 Implementation

In a July 6, 2015 press release, the organizations announced the following guidance which affects Medicare Part B Fee for Service claims:

"Recognizing that health care providers need help with the transition, CMS and AMA are working to make sure physicians and other providers are ready ahead of the transition to ICD-10 that will happen on October. In response to requests from the provider community, CMS is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set."

Upcoming milestones of CMS' updated implementation operating plan were also detailed and include:

  • Sending a letter in July to all Medicare fee-for-service providers encouraging ICD-10 readiness and notifying them of these flexibilities. To read a copy of the letter, click here
  • CMS will set up a communication and collaboration center to identify and initiate resolution of ICD-10 related issues. As a part of the center, CMS will name an ICD-10 Ombudsman to triage and answer questions about the submission of claims.
  • For 12 months after ICD-10 implementation, Medicare Administrative Contractors (MAC) will not deny Part B claims based solely on the specificity of the ICD-10 diagnosis code, as long as the ICD-10 code used was a valid code from the right family.
  • Part B Medicare Administrative Contractors (MAC) may have advance payment available
    • Should there be Medicare systems issues that interfere with claims processing, CMS and the MACs will post information [on their websites] on how to access advance payments
    • NOTE: CMS does not have the authority to make advance payments in the case where a physician is unable to submit a valid claim for services rendered; therefore it is critical for providers to test prior to implementation
  • Offering ongoing Medicare acknowledgement testing for providers through September 30.
  • Providing additional in-person training through the “Road to 10” for small physician practices.
  • Hosting an MLN Connects National Provider Call on August 27.

 CMS - 2015 Testing

Acknowlegement testing: Providers, clearinghouses and others are welcome to submit acknowlegment test claims now up to October 1, 2015.  Additionally, each MAC will highlight acknowledgement testing by providing 3 separate but dedicated weeks in which real-time help desk support will be provided during those weeks.  The acknowledgement testing weeks will occur in: November 2014, March 2015, and June 2015. Refer to Noridian's website for more information about this testing.Remember, acknowlegement test claims will not be adjudicated but rather an 277A acknowlegment will be returned to you confirming that the test claim was accepted or rejected. 

End-to-end testing: The last 2015 end-to-end testing with CMS will take place in July; testing volunteer registration is closed and all volunteers have been chosen.  Read more about CMS' testing in the CMS MLN Matters, edition number SE1409.  

CMS' Road to 10 Resources for Small Physician Practices

This website contains a plethora of resources as well as interactive tools that will create personal action plans for your practice. For example, creating an ICD-10 implementation plan and communicating with more of your vendors are crucial to a successful ICD-10 transition; CMS has created a road map on how to prepare for small, medium and/or large practice transitions, as well as a comprehensive list of questions to ask vendors for you.  

In addition to the resources and interactive tools, Road to 10 offers a template library that contains Assessment and Question lists for diagnosis inventory and your vendors (e.g. technology, billing service, clearinghouse, and payer). Learn more.

Learn more about all the website has to offer.

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ICD-10 Training

The transition to ICD-10 will involve all aspects of the medical practice and as such will require training for coding and billing staff as well physicians and other clinical staff and office staff.

The OMA has developed a comprehensive educational program that will provide targeted trainings at various stages of the ICD-10 implementation timeline, as well as newsletters, case studies and an ICD-10 hotline.

Learn more and register for live and on-demand ICD-10 workshops and webinars here.

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OMA Resources

OMA's ICD-10 E-mail Hotline will be postponed to closer align with the new implemenation date...check back here for updates! 


OMA Member Benefits

Ready10 tools offer fast, easy, and affordable tools that will help your practice ensure a successful transition to ICD-10:

  • Special FREE member offer! Order the web-based Ready10™ Translator for FREE today! The translator converts ICD-9 codes to more specific ICD-10 codes in seconds. This proprietary crosswalk tool is accessible from any computer and features multiple code lookups, bi-directional conversion, print capabilities, and the ability to save favorites and create flash cards to serve as documentation training tools for your entire staff.
  • The Ready10™ Basic delivers everything you need to prepare and manage your practice through the transition – all in one place. It’s a user-friendly, comprehensive step-by-step road map for the ICD-10 transition that works as a web-based “virtual consultant” and includes all the tools needed for a smooth transition.
  • The Ready10™ Pro includes everything from the Ready10 Basic package plus five hours of personalized, expert consulting, plus review of 50 charts to see how your current documentation practices stack up to ICD-10’s increased specificity. With the help of Ready10 Pro, your entire practice will be fully engaged and ready for the transition.

Learn more and order these valuable resources today at www.cpticdpros.com/OMA.

ICD-10 coding books from the AMA can help with your implementation and planning. Publications include:

  • 2015 ICD-10-CM Codebook
  • 2015 ICD-10-CM Mappings
  • Advanced Anatomy and Physiology for ICD-10-CM/PCS 2015

OMA members receive a discounted rate. Order online at www.theOMA.org/store or contact Rachel Holguin at (503) 619-8000 or rachel@theOMA.org for more information.

Managing Your Transition to ICD-10 Newsletter

This periodic OMA newsletter provides ICD-10 information including fact sheets, coding case studies, GEMS updates, preparation tips and hands-on exercises to assist in your practice's preparation.

Medicine In Oregon Magazine (ICD-10 articles)

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Additional Resources

  • DMAP GEMS in Oregon Data
  • According to DMAP’s website, they expect to begin testing in early 2014.  Further, DMAP does not plan to support ICD-9 codes for dates of service after the ICD-10 compliance date, and they plan to closely follow communications from CMS on this.  For details, visit www.oregon.gov/oha/healthplan/Pages/providers.aspx and type "ICD-10" in the Search box. 
  • Log-in to the provider portal to access ICD-10 information within the website.

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