Implementing a New Coding System? You May Have Protection

During their annual meeting in June, the American Medical Association (AMA) voted in favor for a 2-year grace period for practices rolling out new medical coding systems. As you may have heard, the ICD-10 transition, which will work with Medicare and Medicaid reimbursement and is intended to document and code patient care with profound detail, is expected on October 1st, 2015. The AMA’s vote was intended to protect practices with new coding systems from being punished for mistakes and malfunctions associated with the new system. The ultimate goal of all practices, both private physicians and hospitals, is to provide proper medical attention to patients in a timely manner. Preventative steps like the AMA vote should help to relieve some of the major adjustments that will inevitably occur with the ICD-10 mandate.

This decision was no simple matter. The June meeting involved a long hearing about how to deal with the ICD-10 transition and the challenges that come along with it. Previously, the AMA lobbied to remove the transition mandate. Knowing that removal (and most likely delay) is no longer a possibility, the association has resolved to helping practices successfully transition.

What Power Does the AMA Have?

The AMA does not have power to make federal policies, but the association’s role in delivering a national consensus on medical policies like the ICD-10 mandate will be able to provide considerable protection for the first two years. The Centers for Medicare and Medicaid (CMS) are also working with the AMA to minimize penalizations for coding errors after October 1st. Protection against mistakes and errors will include:

-There will be no penalization if codes are in the correct code family but are not specific enough.

-Coding rules will comply with the pre-existing PQRS (Physician Quality Reporting System).

-The CMS will create an ICD-10 Coordination Center that will serve as a help line for questions regarding coding flexibility and the submission of ICD-10 claims. The center will provide an Ombudsman to take on provider and physician claim issues.

What If My Practice Is Small?

Small or rural practices have an additional concern with getting over the hump of the ICD-10 transition. With over 55,000 new codes, ICD-10 is warned to become a threat to productivity. Smaller practices with limited staff and resources will have an exceptionally difficult time adjusting to the new medical coding system. The “Protecting Patients and Physicians Against Coding Act,” proposed by Alabama Congressman Gary Palmer, is specifically intended to provide a helping hand to small, rural practices. This act also proposes a 2-year grace period.

Other Questions About Your Protection?

If you have further questions about the AMA’s 2 year period of extended protection, the Centers for Medicare and Medicaid Services have issued a useful Frequently Asked Questions guide for the ICD-10 Transition. Additionally, the CMS site resources available for on-going issues relating to Medicare and Medicaid.

The certified staff members at Applied Medical Systems in Durham, NC can also serve as a resource for your coding questions and concerns. Feel free to contact us anytime in the upcoming months as your medical practice transitions to the new coding mandate.