ICD-10 Grace Period Bills Could Hurt Implementation
Last week, we reviewed a new bill that would allow for a new two-year “grace period” for accepting the new set of ICD-10CM/PCS code that was presented to the US House of Representatives. Now, we will examine its potential for negative impact on implementation.nnNew legislation that calls for a grace period or transition period to ICD-10 is misguided and could have negative impacts on implementation of the new code set, according to proponents of ICD-10.nnA safe harbor would compromise the ability of Medicare to monitor quality of care, the Coalition for ICD-10 writes in a post on its website.nnThe coalition says recent bills asking for transition or grace periods focus on the assumption that coding in ICD-10 impacts physician payments and will be a burden on providers. These assumptions, the coalition says, are false.nnIn addition, a two-year transition period could be a massive risk when it comes to audits, said Juliet Santos in an opinion piece at ICD-10 Monitor.nnThe comments are in response to a bill proposed by Rep. Gary Palmer (R-Ala.) that would provide a grace period of two years for providers set to transition from ICD-9 to ICD-10 this October. During the grace period, physicians and other providers would not be “penalized for errors, mistakes and malfunctions relating to the transition,” FierceHealthIT previously reported.nnThat’s in addition to legislation brought forth by Rep. Diane Black (R-Tenn.) that would require the Health and Human Services Department to offer end-to-end testing of the code set, as well as an 18-month transition period.nn
These bills, the Coalition for ICD-10 says, could:n
- n
- Restrict Medicare’s ability to determine coverage, medical necessity and quality of care
- Ignore Medicare’s “fiduciary responsibility to ensure proper payment”
- Raise fears about the possibility of fraud and abuse
- Encourage incomplete documentation
n
n
n
n
nSantos adds that if Palmer’s bill is passed, it will void any audit-protective effects of ICD-10.nnThe Centers for Medicare & Medicaid Services “surely cannot afford a bill that condones ‘runaway costs’ through lenient reimbursement strategies at a time when fraud and abuse seem to be so rampant in healthcare,” she says.nnHowever, despite the chance problems could arise from legislation that calls for a transition period, there are some who want to take it even farther–Rep. Ted Poe (R-Texas) recently introduced a bill to Congress that would ban ICD-10 outright.nnThis article originally posted on FierceHealthIT.com.
American Airlines, back in 2008, started charging for checked baggage (really, I looked it up!). Up to that point, and even today, most of us have thought that the cost of the ticket should include the cost of checking a bag! As it turns out, the ticket price is only for getting us safely (not even necessarily comfortably) from point A to point B. The rest (food, bags, drinks, in-flight entertainment, etc.) is an up charge.nnIs ambulatory medical care really that much different? The contracted reimbursement rate is for safe, quality and effective medical care. Could everything else (some things) be an up charge? Think about all those administrative services your practice provides to make the health care system work: filling out paperwork, making referral authorizations.nnStay tuned for more Todd’s Tips!nn
About R. Todd Welter • MS, CPCnFounder and President of Welter Healthcare Partners
T75.1XXA — Swimmer’s crampnnH60.331 — Swimmer’s ear, right earnnB65.3 — Swimmer’s itchnnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to 
The Sustainable Growth Rate (SGR) has been repealed! However, (and there is always a however) it has been replaced with a potentially much more caustic new scheme. The Feds are going to force providers into the quality reporting, clinical practice improvement and EHR MU world. They call it MIPS. Not participating will cost you up to a 9% reduction in Medicare reimbursement by 2022. It’s time to get serious about measuring and improving quality, etc. If you are not on a MU EMR, it’s time! Doing so will potentially get you an additional 9% by 2022.nnStay tuned for more Todd’s Tips!nn
W56.01XA — Bitten by dolphin, initial encounternW56.12XS — Struck by sea lion, sequelanW56.22XA — Struck by orca, initial encounternW56.31XA — Bitten by other marine mammals, initial encounternnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to 
A new two-year “grace period” for accepting the new set of ICD-10CM/PCS codes has been presented in the form of a new bill to the US House of Representatives.nnThe bill, 
During the two-year grace period physicians would not be penalized and their payments would not be withheld by CMS due to “coding errors, mistakes, and/or malfunctions of the system,” according to the bill. The Department of Health and Human Services (HHS) would also be required to conduct a study on how the transition to ICD-10 has affected physicians and other healthcare providers, and state how well HHS has helped physicians transition to the new code set.nnThe bill is needed, Palmer said, because small and rural physicians have not had adequate time or resources to transition to ICD-10, and that learning to do so by October would harm their ability to provide quality patient care and receive proper reimbursement.nnOther healthcare stakeholders have argued that the transition time from ICD-9 to ICD-10 has been ample enough. Also, ICD-10 advocates have pointed out that currently CMS offers numerous resources to help physicians and other providers with the transition, including fact sheets, checklists, guides, timelines, teleconferences, videos, and local training programs, through their Road to ICD-10 website located at 
AHIMA Against H.R. 2652
While this bill implies that the increase in the number of codes in ICD-10 will cause hardship for physicians trying to find the right code, AHIMA officials counter that physicians and any other medical biller won’t need to learn every ICD-10 code in order to properly bill.nnJust as no healthcare provider uses every code in ICD-9-CM today, physicians and other providers will not use all the codes in ICD-10-CM, AHIMA stated in an