Coalition comes out swinging against ICD-10 safe harbor

Could lead to fraud and abuse, incomplete documentation, industry group argues
By Mike Miliard
09:28 AM
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More than one ICD-10 bill has been introduced in Congress recently aiming to create a "safe harbor" for physician claims denial post-switchover. But the Coalition for ICD-10 has put forth six reasons why such a plan would have "far-reaching, negative consequences."

Two bills in recent weeks specifically aim for safe harbor protections. One, Tennessee Republican Rep. Diane Black's Increasing Clarity for Doctors by Transitioning Effectively Now (ICD-TEN) Act, calls for physicians to be exempt from denied claims "due solely to the use of an unspecified or inaccurate [ICD-10] subcode." Another, Alabama Republican Rep. Gary Palmer's Protecting Patients and Physicians Against Coding Act of 2015, similarly seeks protection "for errors, mistakes or malfunctions" relating to ICD-10 submissions.

The Coalition for ICD-10 seems to see this legislation as something of a camel's nose.

First, it calls attention to the fact that, "even though these bills are intended to respond to physicians’ concerns, the safe harbor appears to apply to all providers including hospitals."

[See also: New bill aims for ICD-10 'transition' period]

Moreover, the coalition argues, "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."

The group makes the case that ICD-10 diagnoses don't directly impact physician payment, as "the amount paid is determined by the reported CPT codes."

[See also: Lawmakers propose ICD-10 two-year 'grace period']

In addition, it argues that ICD-10 won't be the burden for physicians it's detractors say it will be: "Much of the expanded detail in ICD-10 is very basic information that should be readily available in the medical record."

Finally, the Coalition for ICD-10 says safe harbor could be bad for the industry – potentially leading to fraud and abuse, incomplete documentation and more adverse effects.

Healthcare IT News' sister site Medical Practice Insider has a run-down of the coalition's six arguments against safe harbor. Read them here.