Bill Seeks To Delay Provider Penalties for Inaccurate ICD-10 Codes

June 10, 2015 in News

Last week, Rep. Gary Palmer (R-Ala.) introduced a bill (HR 2652) that would give providers more flexibility when submitting claims using the new ICD-10 code sets, Healthcare IT News reports (McCann, Healthcare IT News, 6/9).

U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures by Oct. 1.

Bill Details

The bill, called Protecting Patients and Physicians Against Coding Act of 2015, would create a two-year grace period during which providers would not be denied Medicare or Medicaid payments because of coding errors when submitting claims (Gruessner, EHR Intelligence, 6/9).

In addition, the bill, which has gained 35 co-sponsors, would require a study be conducted that examines how the coding transition has affected the health care industry, particularly providers located in rural area (Healthcare IT News, 6/9).

In a release, Palmer wrote that the ICD-10 transition poses a significant administrative burden, noting, “ICD-10 includes a five-fold increase in coding, which threatens to hurt productivity, increase mistakes either from human or technological errors, and create confusion and difficulties as a result” (Palmer release, 6/4).

He wrote that the grace period would allow providers to “focus on patient care instead of coding and receiving compensation for their care while ICD-10 is being fully implemented” (Slabodkin, Health Data Management, 6/10).

Reaction

The bill is similar to a new policy approved this week by the American Medical Association (Pittman/Tahir, “Morning eHealth,” Politico, 6/9). Under the policy, CMS would not withhold payments for coding mistakes made during the transition period (iHealthBeat, 6/9).

Meanwhile, American Health Information Management Association has come out against Palmer’s bill, arguing that the grace period would lead to inaccurate coding, improper payments and potential medical billing fraud. In addition, the group noted that coverage determinations and validation of medical necessity of health care services would be affected since they rely on codes submitted in claims (Health Data Management, 6/10).

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