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Friday Sep 25, 2015

CMS issues more clarification on ICD-10 flexibility

On July 6, the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association released a joint statement( about their efforts to help physicians get ready for the Oct. 1 switch to ICD-10 coding. This statement included guidance from the CMS( that allows for flexibility in the claims auditing and quality reporting processes.

CMS released a series of frequently asked questions and answers about the changes in late July. The agency has now reissued those questions and answers( with revisions to questions 1 and 9, as well as adding nine new questions and answers.

Revised question 1 provides the name and email address for the new ICD-10 ombudsman, William Rogers, MD. Revised question 9 makes it clear that the new flexibility of the ICD-10 Medicare fee-for-service audit and quality program does not extend to any Medicare fee-for-service prior authorization requests. Among the topics addressed in the new questions and answers are:

•    How does the guidance and flexibility relate to Medicare Advantage?
•    How can physicians access advance payments if their Part B Medicare Administrative Contractors are unable to process claims within established time limits because of administrative problems?
•    Will Medicare’s processes change regarding what elements are crossed over to supplemental payers (including commercial payers and state Medicaid agencies)?

Please visit the CMS ICD-10 website( for all of the latest news related to ICD-10 implementation.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Posted at 12:16PM Sep 25, 2015 by David Twiddy

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