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AMA Calls for ICD-10 Grace Period, MU Changes

June 9, 2015
by Rajiv Leventhal
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The American Medical Association (AMA) is seeking a two-year ICD-10 grace period for physicians to avoid financial penalties to facilitate a smoother transition to the new coding set, and is also requesting that the feds fix meaningful use before moving on to Stage 3.

Regarding ICD-10, physicians at the 2015 AMA Annual Meeting passed policy calling on the Centers for Medicare & Medicaid Services (CMS) to wave penalties for errors, mistakes or malfunctions in the system for two years directly following implementation. The policy stipulates that CMS should not withhold physician payments based on coding mistakes, “providing for a true transition, where physicians and their offices can work with ICD-10.”

This is in line with two recent bills introduced into the U.S. House of Representatives.  The first legislation, the Increasing Clarity for Doctors by Transitioning Effectively Now Act (ICD-TEN Act) introduced in May, 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,” according to the bill, which was presented by Rep. Diane Black (R-TN).

The more recent legislation, the Protecting Patients and Physicians Against Coding Act of 2015, was introduced by Representative Gary Palmer (R-AL-6) on June 4. This bill, H.R.2652, would create a two-year grace period where healthcare providers’ ICD-10-based claims submitted to Medicare and Medicaid would not be denied due to coding errors. Implementing this grace period would ensure physicians are not negatively impacted while ICD-10 is “fully implemented within the healthcare system,” according to a letter sent by Palmer to fellow Congressmen asking for their support of the bill.

“The bottom line is that ICD-10 will significantly overwhelm physician practices with a 400 percent increase in the number of codes physicians must use for diagnosis, which will take time away from the valuable one-on-one patient-physician interface that is the hallmark of taking the best care of patients,” Russell W.H. Kridel, M.D., member of the AMA Board of Trustees, said in a statement. “We continue to press both Congress and the administration to take necessary steps to avoid widespread disruption to physician practices created by this overly complex and burdensome mandate. Coding and billing protocols should never get in the way of patients receiving high quality care.”

What’s more, AMA recently told CMS that it thinks the agency should stop and assess the meaningful use program before moving forward with Stage 3. According to AMA, “The notoriously burdensome program could undergo changes that will make it easier for physicians to achieve success through 2017. However, it will take time for those changes to take effect, which is one of the reasons the AMA is urging CMS to assess the impact of the proposed changes before implementing Stage 3 in 2018.”

If CMS does indeed go forward with Stage 3, AMA recommends several changes that it thinks need to be made, including:

  • Making 2017 a transitional year to alleviate many of the concerns both vendors and providers have regarding program updates, system changes and reengineering workflows
  • Implementing a reporting period that is less than a full year, to accommodate many unforeseen system disruptions that can occur outside the physician’s control
  • Consulting physicians and vendors before removing or adding measures
  • Heavily modifying the proposed objectives to align with the needs of medical specialists
  • Allowing quality measures reported to clinical registries to count for meaningful use quality reporting requirements

The proposed Stage 3 rule was released in March, and late last month, various healthcare advocacy groups and other stakeholders questioned the logic behind some of the components of the rule.



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