This week, the Coalition for ICD-10, a broad-based healthcare industry advocacy group, slammed two bills introduced into Congress that would create a “safe harbor” for physicians as they transition to the new coding set.
One bill, 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. The other bill, H.R.2247, introduced in May, 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.” Both of these legislations were House bills.
The ICD-10 Coalition’s response to these bills was not pleasant. It said, “Supposedly, the goal is to ease physicians’ transition to ICD-10 and reduce their financial risk as they become accustomed to submitting ICD-10 codes. Even though these bills are intended to respond to physicians’ concerns, the safe harbor appears to apply to all providers including hospitals. These bills are predicated on the assumption that the coding of ICD-10 diagnoses directly impacts physician payments and that ICD-10 coding will be a burden because required ICD-10 detail is not readily known or available in the medical record. Both of these assumptions are false.”
Beyond being based on false assumptions, the Coalition said that creating a “safe harbor” has far-reaching, negative consequences for the healthcare delivery system, including:
- Safe harbor undermines determination of coverage, medical necessity and quality of care
- Safe harbor ignores Medicare’s fiduciary responsibility to ensure proper payment
- Safe harbor raises serious fraud and abuse concerns
- Safe harbor encourages incomplete documentation—a quality of care issue
- Safe harbor would lead to widespread system disruptions
- Safe harbor is just another delay by a different name
In conclusion, the Coalition wrote, “The entire healthcare industry has made the investment to be ready…For a physician who does not perform uncovered or medically unnecessary services, the only impact of ICD-10 diagnosis coding will be on quality of care measures. Thus, the sole effect of a safe harbor will be to compromise the ability of Medicare to monitor quality of care. Such a result is completely contrary to a move from paying for volume to paying for value in the Sustainable Growth Rate (SGR) reform legislation (H.R. 2).”