AMA and CMS Team Up for Smoother ICD-10 Transition

In a joint statement Monday, the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS) announced new guidance to help ease providers into the transition from ICD-9 to ICD-10. The guidance was released in response to physician concerns about the claims auditing and quality reporting processes associated with the transition.

According to the joint statement, CMS and the AMA “will in parallel be educating providers through webinars, on-site training, educational articles and national provider calls to help physicians and other health care providers learn about the updated codes and prepare for the transition.”

AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA, said “The American Health Information Management Association (AHIMA) commends the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) for collaborating on additional measures to provide further support to physicians for the ICD-10 transition… AHIMA will continue to work diligently with the industry so that on Oct. 1 we can all smoothly transition to ICD-10 and begin to realize the myriad benefits of ICD-10 such as more effective, safer and better patient care.”

Additional resources and policies CMS will be providing include:

  • The creation of an ICD-10 Ombudsman to help receive and triage physician and provider issues. The Ombudsman will work closely with representatives in CMS’ regional offices to address physicians’ concerns.
  • For 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family of codes.
  • However, a valid ICD-10 code will be required on all claims starting on October 1, 2015. It is possible a claim could be chosen for review for reasons other than the specificity of the ICD-10 code and the claim would continue to be reviewed for these reasons. This policy will be adopted by the Medicare Administrative Contractors, the Recovery Audit Contractors, the Zone Program Integrity Contractors, and the Supplemental Medical Review Contractor.
  • When the Part B Medicare Contractors are unable to process claims within established time limits because of administrative problems, such as contractor system malfunction or implementation problems, an advance payment may be available.


Click here for more details on the guidance.

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