The American Medical Association and Centers for Medicare and Medicaid Services (federal CMS) jointly announced on July 6, 2015, that agreement has been reached on important elements of a "grace period" for the Oct. 1, 2015, implementation of the ICD-10 diagnosis code set. For a one-year period starting Oct. 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. The Colorado Medical Society delegation to the AMA was instrumental in formulating this policy.

Read more on CMS.org.

Do you have claims that will span the ICD-10 implementation date of Oct. 1, 2015? The federal CMS has guidance for providers:

• MLN Matters� Special Edition Article SE1408, "Medicare FFS Claims Processing Guidance for Implementing ICD-10 - A Re-Issue of MM7492"
• MLN Matters Special Edition Article SE1325, "Institutional Services Split Claims Billing Instructions for Medicare FFS Claims that Span the ICD-10 Implementation Date"
• MLN Matters Special Edition Article SE1410, "Special Instructions for ICD-10 Coding on Home Health Episodes that Span Oct. 1, 2015"

Services for accredited Diabetes Self-Management Education (DSME) to Medicaid members under certain conditions is a covered benefit beginning on July 1, 2015. Two new procedure codes are being added to the benefits of Colorado Medicaid, G0108 (individual classes) and G0109 (group classes). Facilities providing diabetes self-management education can bill using revenue code 0942 and identify the appropriate procedure codes on the claim. Individual providers that render diabetes self-management education can bill the procedure codes.

Read more on CMS.org.

The Centers for Medicare and Medicaid Services (CMS) released the proposed Medicare physician fee schedule (PFS) rule for 2016. CMS will accept public comments on the rule until Sept. 8, 2015 and intends to issue the final 2016 PFS by Nov. 1, 2015.

The proposed rule:

• Sets 2016 Medicare payment rates for physician services, including a modest payment increase as a result of the SGR repeal under the Medicare Access and CHIP Reauthorization Act (MACRA);
• Establishes criteria for the 2016 performance year for the value-based payment modifier (VBPM), which could result in penalties of 4 percent in 2018 for high cost/low quality providers;
• Details criteria for 2016 performance in PQRS to avoid a 2 percent penalty in 2018;
• Outlines proposed RVU and payment changes for services CMS considers misvalued;
• Increases the amount of information about physicians and practices on the Physician Compare website, including information pertaining to quality measure and VBPM performance; and
• Includes discussion of how the agency may consolidate existing Medicare quality reporting programs in the coming years, as required under MACRA.

In a separate rule, CMS proposed changes to policies and payments regarding hospital outpatient and ambulatory surgical centers. Visit the Federal Register to view the full proposed 2016 Medicare PFS or view the CMS fact sheets.

The AMA Government Accountability Office (GAO) is working on a report to assess the federal CMS's efforts to develop and test its system changes for the transition to ICD-10 codes and support stakeholders' efforts to modify their own related systems by the Oct. 1, 2015, deadline. This work is focused specifically on information technology (IT) issues related to the ICD-10 transition - regarding both the agency's internal systems (i.e., the shared systems and common working file) and Medicare stakeholders' systems that are used to submit claims that are to include the new codes.

As part of their report, GAO is requesting input from physician practices on the following questions.

1. Have alternative methods (e.g., the MACs portals and free billing software) been used by your constituents to file claims in the past?
   1. How often and under what circumstances have these methods been used by your constituents?
2. How effective, if applicable, were the portals and billing software toward helping file claims when systems were not updated to work with CMS's shared systems?
3. How accessible were the tools and instructions for using the alternative methods for filing claims?
4. Please describe the challenges, if any, associated with your constituencies' efforts to use the alternate methods for filing claims.

The deadline to respond to the GAO is Tuesday, July 21. This is a short turnaround, but the AMA asks that you take this opportunity to provide GAO with specific examples of practices' experiences with Medicare alternative claims submission processes.

Please send your responses to Alice Bynum-Gardner, MPH, AMA senior policy analyst, no later than noon CST on Tuesday, July 21, so the AMA can compile the responses and submit them to the GAO by the end of the day. Office: (312) 464-4632; email: [email protected]. Your prompt response and input is appreciated.

Novitas Solutions has launched an educational initiative geared toward helping organizations submit your Medicare Part B claims accurately the first time so they can eliminate the rework in your office, save time and money for other opportunities, and also receive your Medicare payment faster. Go to the Novitas website to access the full series that began in May. Each article addresses a specific issue or billing scenario that may be causing you rework and costing you time and money. Three new articles have been published in the past few weeks focusing on Modifier 76, Modifier 77 and Modifier KX.