ICD-10: CMS Will Give You a Mulligan

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Don’t worry, we’re going to be okay with do-overs, CMS told providers earlier this week in an unconventional joint press release with the AMA.

The cease fire comes after years of sparring over whether ICD-10 implementation should even happen. Just two months ago, AMA was still saying we should all sit tight like Nigel Tufnel and go up 11. But now CMS and AMA seem ready to tackle ICD-10 together. It’s like they’re brand new besties.

Look out for CMS “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” starting October 1, 2015, the agency said. “For the first year ICD-10 is in place, Medicare claims will not be denied solely based on the specificity of the diagnosis codes as long as they are from the appropriate family of ICD-10 codes,” the AMA added.

What this means: Heads up MACs and RACs—CMS will require you to cut providers some slack as everyone adjusts to ICD-10. And, that Q4 2015 cash flow crunch you’re dreading? It may not be so bad after all. “If Medicare contractors are unable to process claims as a result of problems with ICD-10, CMS will authorize advance payments to physicians,” the AMA said.

July 17, 2015 Update: CMS is beginning to outline how advance payments will work. Stay tuned as the agency reveals additional details.

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