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New House Bill Calls for ICD-10 “Transition Period”

May 15, 2015
by Rajiv Leventhal
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Another bill regarding ICD-10 has been introduced into the U.S. House of Representatives. Rather than call for the new coding set to be prohibited like the most recent bill did, this one pushes for a required ICD-10 transition period following implementation on October 1.

This 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,” according to a blog post by the Journal of AHIMA (the American Health Information Management Association).

The bill, introduced on May 12 by Rep. Diane Black (R-TN), would not halt or delay the Oct.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, according to AHIMA.

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.”

The most recent ICD-10 bill, H.R. 2126, introduced by Rep. Ted Poe (R-TX) on April 30, would “prohibit the Secretary of Health and Human Services from replacing ICD-9 with ICD-10 in implementing the HIPAA code set.” Soon after that bill was introduced, AHIMA predicted that it could face difficulty getting through the committee process and to the House floor for a vote.

Similarly, AHIMA is against this bill as well, as it says ICD-10 contingency plans already supported by CMS have been put in place and are working well. 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,” said Margarita Valdez, senior director of congressional relations at AHIMA.

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