House Bill Seeks ICD-10 Grace Period

With the October 1 ICD-10 deadline rapidly approaching, another member of Congress has introduced legislation that would establish a “grace period” following the compliance date during which providers could not be denied Medicare/Medicaid payments because of coding errors.

Rep. Gary Palmer (R-Ala.) has sponsored the “Protecting Patients and Physicians Against Coding Act” (H.R. 2652) which calls for a two-year grace period so that providers can “focus on patient care instead of coding and receiving compensation for their care while ICD-10 is being fully implemented.” With ICD-10’s five-fold increase in codes compared to ICD-9, Palmer warned that the code switchover creates significant administrative challenges for rural and small town providers in particular, who lack the resources to fully prepare for the ICD-10 implementation.

As a result, the congressman said he is concerned that some providers will not receive payments for “what they are owed” due to current law which could prevent them from being reimbursed by the Centers for Medicare and Medicaid Services “because of simple coding mistakes or systemic failures.” According to Palmer, a two-year grace period “will provide time for the system to be implemented and kinks worked out without threatening the quality or availability of healthcare for Americans who live in small towns or rural areas.”

Likewise, Rep. Diane Black (R-Tenn.) recently introduced her own ICD-10 legislation seeking to institute an 18-month transition period beginning October 1, during which no claim submitted for payment by a provider would be denied as a result of using an unspecified or inaccurate code.

Also See: House Bill Would Prohibit HHS from Replacing ICD-9 with ICD-10

While Black’s bill only has five cosponsors, Palmer’s bill has 32 original cosponsors—including House Budget Committee Chairman Tom Price, M.D. (R-Ga.) and Rules Committee Chairman Pete Sessions (R-Tex.)—and has been referred to the Committees on Energy & Commerce and Ways & Means.

However, the American Health Information Management Association opposes Palmer’s bill on the grounds that the ICD-10 grace period would lead to inaccurate coding, improper payments, and potential medical billing fraud, opening the door to both intentional and unintentional coding errors. According to AHIMA, coverage determinations and validation of medical necessity of healthcare services also depend on codes submitted on claims and would be negatively impacted.

AHIMA counters Palmer’s assertion that the increase in the number of codes in ICD-10 versus ICD-9 will cause hardship for physicians by arguing that doctors and medical billers won’t need to learn every ICD-10 code in order to properly bill.

“Just 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,” states an AHIMA Frequently Asked Questions about ICD-10 document. “They will use a subset of codes based on their practice and patient population. The ICD-10-CM code set is like a dictionary that has thousands of words, but individuals use some words very commonly while other words are never used.”

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