Home Health & Hospice Week

Home care providers need a break too, they tell CMS.

Wouldn’t it be nice to get a little leeway on your diagnosis coding when ICD-10 hits Oct. 1? You can ask physicians if it is, because right now they are scheduled to get some while all other provider types are not.

Reminder: In guidance posted last month, the Centers for Medicare & Medicaid Services said that 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. But the grace period applies only to Part B physician services, according to the announcement.

If anything, home care and hospice providers should be more deserving of leniency because — unlike most physician practices — they do not routinely have certified coders on staff, said one provider in the question-and-answer portion of the Aug. 12 CMS Open Door Forum for home care providers.

Home health and Durable Medical Equipment providers that rely on physician documentation to justify their claims will be left high and dry if the docs’ ICD-9-compliant documentation isn’t up to ICD-10 standards, added a DME provider in the Q&A.

These Providers Face Double Burden

Hospices will be especially burdened by ICD-10 with no grace period, since they also will be ramping up on new coding requirements as part of the 2016 final rule at the same time, a hospice provider noted in the forum.

CMS staff in charge of the matter were not in the forum. Whether the leniency granted to physicians will be extended to other types of providers is “an open question,” CMS’s Wil Gehne noted in the call. v

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