Question 4: What is advanced payment and how can I access this if neededĪnswer 4: When the Part B Medicare Contractors are unable to process claims within established time limits because of administrative problems, such as contractor system malfunction or implementation problems, an advance payment may be available. Furthermore, an EP will not be subjected to a penalty if CMS experiences difficulty calculating the quality scores for PQRS, VBM, or MU due to the transition to ICD-10 codes.ĬMS will not deny any informal review request based on 2015 quality measures if it is found that the EP submitted the requisite number/type of measures and appropriate domains on the specified number/percentage of patients, and the EP’s only error(s) is/are related to the specificity of the ICD-10 diagnosis code (as long as the physician/EP used a code from the correct family of codes). CMS will continue to monitor the implementation and adjust the timeframe if needed. Question 3: What happens if I use the wrong ICD-10 code for quality reporting? Will Medicare deny an informal review request?Īnswer 3: For all quality reporting completed for program year 2015 Medicare clinical quality data review contractors will not subject physicians or other Eligible Professionals (EP) to the Physician Quality Reporting System (PQRS), Value Based Modifier (VBM), or Meaningful Use (MU) penalty during primary source verification or auditing related to the additional specificity of the ICD-10 diagnosis code, as long as the physician/EP used a code from the correct family of codes. 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. 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. However, a valid ICD-10 code will be required on all claims starting on Oct. Question 2: What happens if I use the wrong ICD-10 code, will my claim be denied?Īnswer 2: 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. As we get closer to the October 1, 2015, compliance date, CMS will issue guidance about how to submit issues to the Ombudsman. ![]() The Ombudsman will work closely with representatives in CMS’s regional offices to address physicians’ concerns. Ombudsman to help receive and triage physician and provider issues. As part of the center, CMS will have an ICD-10 This center will quickly identify and initiate resolution of issues that arise as a result of the transition to ICD-10. CMS will set up a communication and collaboration center for monitoring the implementation of ICD-10. 1 2015?Īnswer 1: CMS understands that moving to ICD-10 is bringing significant changes to the provider community. ![]() Question 1: What if I run into a problem with the transition to ICD-10 on or after Oct. The first four questions and answers were released July 6, and the corresponding 13 questions and answers were released as clarification on July 27. ![]() The following are frequently asked questions created by the Centers for Medicare & Medicaid Services and the American Medical Association regarding ICD-10. 1, 2015, all health care providers will be required to switch from ICD-9 to ICD-10 for coding of medical diagnoses and inpatient hospital procedures. If you continue to have this issue please contact to Healio
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |