New bill aims for ICD-10 'transition' period

'It is essential for CMS to ... institute safeguards that prevent physicians and hospitals from being unfairly penalized due to coding errors'
By Tom Sullivan
01:27 PM
Paperwork and stethoscope

One thing about ICD-10 is becoming crystal clear: The compliance deadline is not going to arrive without Congressional resistance.

Tennessee Republican Rep. Diane Black – a former nurse, according to her website – added a new wrinkle to the discourse by introducing a House bill this week that would essentially institute an ICD-10 transition period.

The text for H.R. 2247 is not yet available on Congress.Gov, which posts proposed legislation a couple days after it gets introduced, but the entry for it states Black’s intention.

"To require the Secretary of Health and Human Services 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."

An important point is that the bill does not push back the Oct. 1, 2105 compliance deadline but, rather, calls for an 18-month transition period wherein "HHS would be required to submit a report to Congress certifying whether or not the ICD-10 standard is fully functional and not hindering the fulfillment of provider claims," according to an article in The Journal of AHIMA. "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."

In addition to the testing, Black’s bill would prohibit the Centers for Medicare and Medicaid Services from denying claims submitted with unspecified or inaccurate subcodes.

"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 to legislators. "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 bill – literally named the ICD-TEN Act, as in Increasing Clarity for Doctors by Transitioning Effectively Now – comes two weeks after Louisiana Republican Senator Bill Cassidy, MD, publicly suggested to HHS Secretary Sylvia Burwell that with so many providers unprepared to flip the ICD-10 switch come Oct. 1, "the reasonable thing would be to delay the penalty phase two years as people transition." That would mean continuing to accept, process and pay claims made using either ICD-9 or ICD-10 codes.

Black’s ICD-TEN bill will no doubt be welcomed by those providers that have yet to make much progress toward ICD-10 or partake in CMS end-to-end testing, and it will also be met with some consternation from the healthcare organizations and industry associations fed up with procrastination who just want transition to happen.

So now we have Texas Republican Rep. Ted Poe trying to kill the ICD-10 conversation outright and Black taking the middle ground with a transition period. 

Which makes more sense? 

Related articles: 

3 things to know about the Cutting Costly Codes Act of 2015

Should HHS delay ICD-10 'penalty phase' for two years? 

ICD-10: What's different this time?

3 ways Congress could still kill ICD-10

See the next page for Rep. Black's legislative profile.

More regional news

Above photo: Dr Gamaliel Tan (in grey), Group CMIO, NUHS during NTFGH's HIMSS EMRAM 7 revalidation (virtual) in November 2020. Credit: NTFGH

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