In a move that should signify that there will be no further surprise delays to the switch to ICD-10 coding, the American Medical Association has publicly expressed support for newly announced flexibility in enforcement of the rules. This news came in concert with the release of new guidance from Centers for Medicare and Medicaid Services that has the AMA’s blessing.
Responding to a request from the AMA, CMS on Monday announced that it would not penalize providers during the first year of ICD-10 use if their diagnosis codes are not specific enough, as long as the codes come from the proper code “family. ” The same policy will apply to coding as it applies to reporting for the Physician Quality Reporting System, Meaningful Use or CMS value-based payment programs.
In addition, CMS said it would establish an ICD-10 Coordination Center and name an ICD-10 ombudsman to answer questions from healthcare providers — particularly small physician practices — about ICD-10 claims submission.
“With easy-to-use tools, a new ICD-10 Ombudsman, and added flexibility in our claims audit and quality reporting process, CMS is committed to working with the physician community to work through this transition,” acting CMS Administrator Andy Slavitt said in a joint announcement with the AMA.
Among the tools Slavitt referenced is Road to 10, a website CMS put up last month to help small practices with the switch.
AMA President Dr. Steven J. Slack was effusive. “These provisions are a culmination of vigorous efforts to convince the agency of the need for a transition period to avoid financial disruptions during this time of tremendous change.” he wrote on an AMA blog.
“These significant improvements for the impending ICD-10 roll-out are just one way our collective voice is helping improve our practice environment for greater practice stability and ongoing quality care,” Slack added.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
The ICD-10 compliance deadline had been set for Oct. 1, 2014, but language quietly inserted at the last minute into Medicare “doc fix” legislation in March 2014 put off implementation for a year. It is widely believed that influential provider lobby groups, including the AMA, quietly got to key members of Congress shortly before the final vote to delay ICD-10.
