ICD-10 "Grace Period" Agreement Announced

Significant Advocacy by ASCRS/ASOA and Medical Community Results in
ICD-10 Flexibility

Today, the AMA and CMS announced  an agreement was reached on important elements of a "grace period" for the October 1, 2015, ICD-10 implementation. Additional information from CMS, including further guidance, will be issued shortly.

This announcement is a result of significant advocacy efforts from ASCRS and the entire medical community. ASCRS joined the AMA and the medical community in communications to the House of Representatives and Senate requesting Congress work with CMS to mitigate the potential impacts of the transition to ICD-10 by establishing a "grace period" during which physicians will not be penalized for errors, mistakes and or malfunctions related to adjusting to new ICD-10 coding specifications. In addition, ASCRS/ASOA conducted a grassroots campaign in which hundreds of ASCRS/ASOA members joined in the effort. 

The "grace period" will include:

  • For a one year period starting October 1, Medicare claims will not be denied solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes. In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes. This policy will be followed by Medicare Administrative Contractors and Recovery Audit Contractors.
  • To avoid potential problems with mid-year coding changes in CMS quality programs (PQRS, VBM and MU) for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores (i.e., for PQRS, VBM, or Meaningful Use). CMS will continue to monitor implementation and adjust the duration if needed.
  • CMS will establish an ICD-10 Ombudsman to help receive and triage physician and provider problems that need to be resolved during the transition.
  • CMS will authorize advanced payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation.

AMA and CMS published a joint press release and a FAQ document on the announcement of the new "grace period."  The press release states CMS will publish additional details on this "grace period" later today. We will continue to keep you updated.