Trade Groups, Congress Continue to Push for Two-Year ICD-10 Grace Period

Healthcare trade groups and certain members of Congress are continuing to advocate for policies that would add a two-year grace period following the go-live date for ICD-10-CM/PCS.

The American Medical Association’s (AMA) House of Delegates, at its annual meeting this week, passed a resolution Monday asking the Centers for Medicare and Medicaid Services (CMS) to waive penalties for errors, mistakes, or malfunctions in the system for two years directly following implementation of ICD-10, on October 1. The AMA also stipulates that “physician payments will also not be withheld based on ICD-10 coding mistakes, providing for a true transition where physicians and their offices can work with ICD-10 over a period of time and not be penalized,” the resolution states

The resolution was introduced by AMA delegates from Alabama.

The resolution contains similar language to the bill introduced to the US House of Representatives this week by Rep. Gary Palmer (R), who also is from Alabama. Palmer’s proposal follows legislation introduced by Rep. Ted Poe (R-TX-2) on April 30, which seeks to outright stop the replacement of ICD-9 with ICD-10.

While neither of the proposed bills have attracted a significant number of co-sponsors, the concept of a grace period is gaining traction by some members of Congress.

Margarita Valdez, AHIMA’s senior director of congressional relations, said that one congressional supporter of a two-year grace period for ICD-10 brought up language of the proposals on Wednesday during a meeting of the House Ways and Means Committee on Capitol Hill. The hearing discussed the implementation of the Affordable Care Act and the US Department of Health and Human Services FY 2016 budget.

Palmer’s proposal and others like it, claim that the two-year “safe harbor” window is intended to help small, rural physician practices, who they argue will experience a disruption in reimbursement with ICD-10.

Sue Bowman, MJ, RHIA, CCS, FAHIMA, senior director of coding quality and compliance, says the two-year grace period or “safe harbor” is unnecessary as physician payments are based on CPT codes.

“In the physician setting, ICD codes are used to validate medical necessity and determination of coverage of services, Bowman says. “CMS can’t just suspend validation of medical necessity and coverage determination for two years.  That would result in improper Medicare payments and payments for non-covered services.”

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