Policy & Regulation News

House Bill Plans 2-Year ICD-10 ‘Grace Period’ Without Denials

By Jacqueline DiChiara

- The House of Representatives proposes the implementation of a two-year ICD-10 “grace period” to help physicians and healthcare providers more effortlessly transition from ICD-9 into ICD-10. Introduced by Representative Gary Palmer (R-AL-6) on June 4, this new bill – Protecting Patients and Physicians Against Coding Act of 2015, H.R. 2652 – intends to smooth out the code submission process for ICD-10-CM/PCS.

ICD-10 delay

Within the proposed two-year window under H.R. 2652, healthcare providers’ coding errors would not mean a denial of ICD-10 based claims submitted to Medicare and Medicaid. Physicians would hopefully be better alleviated from negative ICD-10 aftermath. Payments would not be withheld and penalizations would not go into effect within the “grace period.”

Under H.R. 2652, there would be no further ICD-10 delay following October 1, 2015. Incorrectly coded claims would be paid for by the Centers for Medicare & Medicaid Services (CMS).

This is the third ICD-10 related bill introduced into the House within the past five weeks. H.R. 2652 shadows the House’s push to freeze ICD-10 implementation, backed by the American Medical Association (AMA). It also follows the House’s proposal of the ICD-TEN bill intended to mandate Sylvia M. Burwell, Secretary of the Department of Health and Human Services, to implement additional transparent testing opportunities.

  • Prior Authorization Costs Rise as Electronic Adoption Remains Low
  • AMA Supports COVID-19 Vaccine Mandates for Healthcare Workers
  • CMS to Repeal Medicare Coverage of Breakthrough Devices Rule
  • The pair of earlier introduced bills has yet to gain momentum. They require many more sponsors and cosponsors to have formal legislative legs, reports the Journal of AHIMA.

    This bill is vital, says Representative Palmer, because rural and smaller physician practices are not yet prepared for the ICD-10 transition. “Although another delay would assist many in the medical community, if ICD-10 is to be implemented on October 1, patient care should not suffer,” states Palmer, in a letter to Congressmen requesting their advocacy.

    AHIMA denies support for H.R. 2652

    The American Health Information Management Association (AHIMA) has voiced a lack of support for this newly proposed House legislation.

    In an interview earlier this year with RevCycleIntelligence.com, AHIMA confirmed a lack of support for further ICD-10 delay. “From our perspective, a delay is not only unnecessary, it’s not a solution to any of the problems that have been raised, such as financial disruptions immediately following the transition,” stated Sue Bowman, MJ, RHIA, CCS, FAHIMA, Senior Director, Coding Policy and Compliance of AHIMA. “I find the whole concept of a delay somewhat interesting because it’s not clear what problem a delay would solve,” she maintained.

    AHIMA officials continue to advocate for the bill as unnecessary legislation, claiming physicians and medical billers do not need to learn a surplus of codes to bill correctly.

    “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,” AHIMA confirms. A two-year grace period, says AHIMA, is also not needed since end-to-end-testing from CMS only claimed a safe 2 percent claim rejection during April 27 to May 1 testing period.

    As the healthcare industry moves from provider uncertainty to certainty, it is hopeful the ICD-10 transition will be financially seamless as the possibility of further House proposals hover along the horizon.