American Medical Association Wins Concessions on ICD-10 Switch

Physicians dreading the Oct. 1, 2015 switch to the new set of Medicare billing codes known as ICD-10 could get a break.

According to the American Medical Association, the US Center for Medicare and Medicaid Services (CMS) has agreed to make 4 changes to ease the transition.

For the first year ICD-10 is in place, Medicare will not deny any claims that are coded improperly—as long as the codes used are from the “appropriate family” of ICD-10 codes, the AMA announced today.

Both Medicare and its recovery audit contractors will be required to follow the new policy.

“This will give physicians and their practice teams time to get up to speed on the more complicated code set,” AMA President Steven Stack, MD said in announcing the changes.

Stack said CMS has also agreed not to penalize physicians who are trying to meet various quality standards for any errors made in reporting what treatments were given patients as part of that “quality care.”

Those rules will apply to the Physician Quality Reporting System, the value-based payment modifier, and to “meaningful use” standards for implementing and using computerized medical records.

CMS has also agreed not to hold up reimbursement payments to physicians if there are claims-processing problems with ICD-10. “CMS will authorize advance payments to physicians,” in such cases, Stack said.

In another concession to physicians, CMS will set up an office of the ICD-10 ombudsman to handle doctors’ problems related to the new set of codes.

At its House of Delegates meeting in Chicago, IL in June, AMA members pushed to get the organization to get CMS to again delay the ICD-10 start date, but Stack said then that was unlikely. The switch had already been pushed back by a year from its scheduled debut in 2014.

But he did promise to try and work with CMS to make the transition less disruptive.

“These provisions are a testament to the power of organized medicine and what we can achieve when we ban together for the good of our patients and our profession,” Stack said today..

Physicians' main objection to ICD-10 is that it has far more codes that the system it replaces. The cost of updating medical records software and training staff to use it is also an issue.

The change is meant to make billing better reflect the true costs of specific services, as well as provide more granular data on care quality and costs for policy analysts, researchers, and payers.