The Centers for Medicare and Medicaid Services (“CMS”) and the American Medical Association (“AMA”) announced adjustments to help providers comply with the requirement to complete their transition from ICD-9 to ICD-10 by the deadline of October 1, 2015. Although these code sets are not a part of HIPAA’s Security and Privacy Rules, they are critical to total HIPAA compliance under the Standard Transactions and Code Sets portion of the Administrative Simplification rules of HIPAA.
CMS said that, for 12 months, Medicare claims will not be denied if providers use the wrong code, as long as the code is in the right category. Federal officials are “also teaming up with the American Medical Association to provide webinars, on-site training and other tools to teach doctors about the new codes to ease the transition to ICD-10 in response to physicians’ concerns that inadvertent coding errors or system glitches during the transition to ICD-10 may result in audits, claims denials, and penalties under various Medicare reporting programs.”
Dr. Stack, President of the AMA, said that the 12-month transition period “will give physicians and their practice teams sufficient time to get up to speed on the more complicated code set.” Congressional Quarterly yesterday added that the AMA “has been pressing for concessions to help its members in smaller practices.”
Even with this adjustment in enforcement, providers should aggressively strive to implement ICD-10 by the deadline.
If you need an explanation of how the Standard Transactions and Code Sets and ICD-10 comport with HIPAA, see Chapters 4-6 in my book, The Compliance Guide to HIPAA and the DHHS Regulations, 6th edition, available on the Veterans Press website.
