Home Health & Hospice Week

Here’s another reason to feel like second-class citizens under Medicare.

Beleaguered home care and hospice providers gearing up for the ICD-10 transition in October could use a little leniency when the implementation date hits. They are out of luck — but physicians are a different story.

If physicians use the wrong ICD-10 code within the first year after Oct. 1, their claims will still be processed and paid, as long as they use an ICD-10 code from the correct code group, the Centers for Medicare & Medicaid Services says in a new guidance document posted to its website. “While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, Medicare review contractors will not deny claims billed under the Part B physician fee schedule … based solely on the specificity of the ICD-10 diagnosis code, as long as the physician/practitioner uses a valid code from the right family,” CMS says in the guidance.

Other ICD-10 developments that home care providers can take advantage of include:

• An ombudsman and communications center. CMS is creating a “communication and collaboration center” and appointing an ICD-10 om-budsman to resolve issues and address concerns. “As we get closer to the Oct. 1, 2015 compliance date, CMS will issue guidance about how to submit issues to the Ombudsman,” the guidance says.

• Advance payment if your MAC faces “administrative problems.” If your MAC experiences a system malfunction or has trouble implementing ICD-10, you might be able to collect a conditional partial payment until the issues are resolved. The advance payments — which require repayment — do not apply if you are unable to submit a valid claim, CMS clarifies. However, if a Medicare systems issue interferes with claims processing, CMS and the MACs will post information on how you can request an advance payment.

Note: The CMS guidance is at www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD-10-guidance.pdf.