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ICD 10 Grace Period: How Does it Work?

Doctors may take advantage of the ICD 10 grace period.The ICD 10 grace period isn’t a myth, but it isn’t a magical fix either. So, what is it exactly? The grace period simply affords a little more time for learning the new coding system because, let’s face it, there are bound to be mistakes. That being said, your practice should be actively learning, whether that means you hire a specific team, professional coder, or third party agency. The time to figure out the kinks is now!

The October 1st deadline for the ICD 10 transition is still in place and private payers will set their own requirements. This means that unless you’ve developed a solid payer relationship and have communicated an agreement for a grace period, your clinic is still liable for that hard date. Incorrect codes, missing documentation, and other errors will not be received without needing to refile or go through an appeals process.

However, CMS announced a grace period that included the following stipulations:

  • Claims will not be denied or audited for one year based on specificity. As long as the family of code from ICD 10 is documented accurately, the code will be accepted.
  • Your practice will not be subject to penalties or calculation of quality scores for the 2015 Quality reporting year (PQRS, VBM, or Meaningful Use) so long as the codes submitted are from the appropriate family.
  • If Part B Medicare contract workers are unable to process claims within the time limits established, advanced payments may be authorized.

As you can see, this grace period still requires precise knowledge and utilization of the ICD 10 code families. But hopefully it reduces the stress placed on clinics worried about penalty actions and making mistakes that are related to the coding specificity.


The ICD 10 grace period isn’t a practice being adopted by all payers, but it is available for some, including Medicare. Contact your payers as soon as possible to verify a grace period before making assumptions, and in the meantime, continue pushing for ICD 10 coding. If you’re feeling too much pressure over the transition despite this grace period, it might be time to seek help.

Billing Advantage is more than just a billing company. We are a network of experienced medical billing agents who can help in practice management and coding, as well as other areas to help your clinic secure financial stability. At Billing Advantage, your patient information is secure and accessible 24/7, enabling you to have as much or little interaction with it as you want. Find out more about our standard billing services, and then contact us for security in your ICD 10 transition.

Donna Whipple Donna Whipple

Donna Whipple, Psy.D. is a clinical psychologist with over 30 years of management experience. She has particular interest and expertise in HIPAA and ethical treatment and business practices in a changing high tech industry. She has a particular talent in boiling down complex regulations so providers can understand and comply with them. As co-owner of Billing Advantage Inc., Donna is involved in all aspects of the company but her particular contributions to the business is in mentoring upper level managers and helping them be more effective in their leadership.

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