After a series of delays, it looks like the U.S. healthcare system will finally upgrade to the ICD-10 coding standard on Oct. 1. While there’s no political will to push back the rollout any further, a new bill introduced in the U.S. House looks to implement a transition period that would protect reimbursements when inaccurate codes are submitted.
H.R. 2247, introduced by Rep. Diane Black (R-TN) last week, would provide a pass to providers for the first 18 months after the switch to ICD-10 and ensure no Medicare reimbursement claim could be denied solely for the use of inaccurate subcodes. However, the bill does not require acceptance of dual coding featuring ICD-9 along with ICD-10.
The bill also would require the Secretary of Health and Human Services (HHS) to use the transition period to conduct end-to-end testing to determine whether ICD-10 is fully functioning and that claims approvals match previous years under ICD-9. HHS would have 30 days after testing is completed to report to Congress on whether ICD-10 is functioning, according to an analysis of the bill from the Journal of the American Health Information Management Association.
“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,” wrote Black in a statement calling for support on H.R. 2247.
AHIMA officials do not support the bill, partly because there are already mechanisms to protect providers during the transition. Existing payment policies from the Centers for Medicare & Medicaid Services (CMS) allow for providers to receive help if delays in billing cause financial difficulties, and CMS has said it could grant “advance payments” to those experiencing issues as a result of the ICD-10 transition, according to AHIMA.
CMS also has already been conducting end-to-end testing with providers, and initial testing resulted in acceptance of more than 80 percent of ICD-10 claims, while only 3 percent of the rejected claims were denied due to invalid ICD-10 codes, according to AHIMA.
H.R. 2247 has been referred to the House Energy and Commerce and Ways and Means committees.