A new bill has been introduced into the US House of Representatives that calls for a required ICD-10 transition period following the code set’s implementation on October 1. The bill, H.R. 2247, the Increasing Clarity for Doctors by Transitioning Effectively Now Act (ICD-TEN Act), would “require the Secretary of Health and Human Services (HHS) to provide for transparent testing to assess the transition under the Medicare fee-for-service claims processing system from the ICD-9 to the ICD-10 standard, and for other purposes.”
The bill, introduced on May 12 by Rep. Diane Black (R-TN-6), would not halt or delay the October 1, 2015 implementation deadline for using ICD-10-CM/PCS, nor would it require the Centers for Medicare and Medicaid Services (CMS) to accept dual coding—claims coded in either ICD-9 or ICD-10. However, the bill would require HHS to conduct “comprehensive, end-to-end testing” to assess whether the Medicare fee-for-service claims processing system based on the ICD-10 standard is fully functioning. HHS would be required to make the end-to-end testing process available to all providers of services and suppliers participating in the Medicare fee-for-service program.
Not later than 30 days after the date of completion of the end-to-end testing process the HHS Secretary would be required to submit to Congress a certification on whether or not the Medicare fee-for-service claims processing system based on the ICD-10 standard is fully functioning.
HHS would need to prove that it is processing and approving at least as many claims as it did in the previous year using ICD-9. If the transition is not deemed “functional” based on this benchmark, HHS would need to identify additional steps that it would take to ensure ICD-10 is fully operational in the near future, according to the bill.
During an 18-month transition period and any ensuing extensions, no reimbursement claim submitted to Medicare could be denied due solely to the “use of an unspecified or inaccurate subcode,” according to the bill.
“In the past, Congress has repeatedly delayed the switch from the ICD-9 coding system to the far more complex ICD-10 system out of concern about the effect on providers. Neither Congress nor the provider community support kicking the can down the road and supporting another delay, but we must ensure the transition does not unfairly cause burdens and risks to our providers, especially those serving Medicare patients,” Black wrote in a letter urging fellow legislators to cosponsor the ICD-TEN Act. “During the ICD-10 transitional period, it is essential for CMS to ensure a fully functioning payment system and institute safeguards that prevent physicians and hospitals from being unfairly penalized due to coding errors.”
AHIMA Against Transition Period
AHIMA officials have stated they are not in favor of this bill since ICD-10 contingency plans already supported by CMS have been put in place, are working well, and will ensure the industry is ready to effectively use ICD-10 in October.
For example, CMS has already begun conducting end-to-end testing with providers, the results of which have been positive and on par with ICD-9 claims. Results from the first week of CMS testing that ran January 26, 2015 to February 3, 2015 showed that 81 percent of test claims submitted by providers in ICD-10 were accepted, according to CMS. During this first round of testing, CMS reported that only three percent of rejected claims were due to invalid submission of an ICD-10 code. Other claims were rejected because of errors unrelated to ICD-10. In addition, providers, suppliers, billing companies and clearinghouses can submit test claims to Medicare any time up to the October 1 implementation date.
This shows the healthcare industry will be ready for ICD-10 on October 1, 2015, and that a transition period is not necessary, said Margarita Valdez, senior director of congressional relations at AHIMA. CMS has done ample outreach and preparation to help the industry prepare, noted AHIMA CEO Lynne Thomas Gordon in a statement on the bill, which has been supported by a recent Government Accountability Office report.
Also, CMS has indicated that it could grant “advance payments” to any physicians that do experience cash flow disruptions as a result of the ICD-10 transition. CMS already has existing payment policies that it uses when a provider has incurred a temporary delay in its billing process causing financial difficulties for a provider, which could be used to help providers after the ICD-10 transition, Valdez said.
AHIMA officials believe that significant payment disruptions for physician practices are not likely since testing has demonstrated that CMS systems are ready to accept and process ICD-10 claims. To further mitigate this risk, AHIMA recommends that CMS grant “advance payments” to any physicians that do experience cash flow disruptions as a result of the ICD-10 transition, Thomas Gordon said.
However, H.R. 2247’s proposed 18-month grace period on coding, where nearly all claims would be accepted, would “create an environment that’s ripe for fraud and abuse,” Valdez said.
“We are concerned about a proposed 18-month ‘transition period’ which should not serve as a reason for providers to delay properly learning to use the new code set and generating accurate codes supported by high-quality clinical documentation, nor to reduce the effectiveness of audits in curtailing fraud and abuse,” Thomas Gordon said in the statement.
In summary, the bill would:
- Still require the use of only ICD-10-CM/PCS beginning October 1, 2015
- Require CMS to conduct full end-to-end testing and to certify to Congress that the Medicare fee-for-service claims processing system is fully functioning using ICD-10
- Implement an 18-month “safe harbor” transitional period after the October 1, 2015 implementation date to protect providers should they make a “minor” mistake using the wrong ICD-10 sub-code
- Prevent the rejection of claims and denial of payment based solely on sub-coding specificity during the implementation phase
The bill was referred to the Committee on Energy and Commerce and the Committee on Ways and Means. Black serves on the Ways and Means Committee. The bill currently has one cosponsor, Rep. Andy Harris (R-MD-1).