Policy & Regulation News

Coalition for ICD-10: Safe Harbor ‘Dangerous’ for Physicians

By Jacqueline DiChiara

- A two-year ICD-10 “grace period” recently proposed by the House of Representatives, among a slew of similarly introduced bills, will result in unnecessary disaster for the healthcare delivery system, says the Coalition for ICD-10. Such consequences, far from being fleeting and forgettable, says the Coalition, will result in the far-reaching deterioration of quality care measures.

ICD-10 delay

The House confirms its beneficial intent of an extended grace period under H.R. 2652 will only help physicians and healthcare providers more seamlessly transition from ICD-9 into ICD-10. Although the American Medical Association (AMA) backs an upcoming ICD-10 freeze, contrasting opinions are circulating, as are industry-wide misconceptions, as October looms nearer. According to H.R. 2652, payments will not be withheld, claims submitted to Medicare and Medicaid will not be denied, penalizations will dissipate within the grace period, and the Centers for Medicare & Medicaid Services (CMS) will pay for incorrectly coded claims.

Further ICD-10 implementation delays must end; the healthcare industry must no longer hesitate to move forward with ICD-10 initiatives, the Coalition stated in an earlier release this month. According to the Coalition for ICD-10’s newest statement, physicians’ financial risk will not be mitigated if this and similar initiatives, such as the Increasing Clarity for Doctors by Transitioning Effectively Now Act (ICD-TEN Act), H.R. 2247, become a legislative reality. A safe harbor will not impact physician payments and will weaken Medicare’s ability to measure quality of care and support coverage and medical necessity, the Coalition states.

Highlights of the Coalition for ICD-10’s statement

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  • The disastrous consequences of an ICD-10 “safe harbor” will be widespread, says the Coalition. The Coalition sanctions:

    • Safe harbor destabilizes definitions of coverage and medical necessity
    • Safe harbor deteriorates quality of care
    • Safe harbor disregards Medicare’s fiduciary obligation to conform the proper execution of payments
    • Critical concerns about fraud and abuse are brewing due to safe harbor proposals
    • Safe harbor fosters partial documentation and the hindrance of care quality
    • Safe harbor will result in massive system disruptions
    • Safe harbor is just a pseudonym or sorts for further ICD-10 delay

    Physician payment will not be directly impacted by ICD-10 diagnoses, says the Coalition. “There is no solid evidence to support the contention that physician practices will experience a significant level of claim denials as a result of the ICD-10 transition," the Coalition states. “The denial rate due to ICD-10 coding errors in the most recent CMS end-to-end testing was only two percent. Therefore, the assumption that there will be substantial ICD-10 related financial disruptions for physicians is false,” the organization maintains.

    Similarly, physicians themselves will not be heavily impacted by ICD-10 diagnoses, the Coalition claims. The Coalition says nearly half of the code number increase is in reference to laterality reporting. “The right/left body part distinction should always be specified in any well-documented medical record,” the Coalition explains. “Indeed, laterality is already a subcode modifier in the CPT coding system developed by the AMA and used by physicians to report procedures. CPT codes are very detailed and yet CPT coding is not considered a burden,” the Coalition alleges.

    Physicians will merely use the subset of codes applicable to his or her specialty and patient population, says the Coalition, confirming no payer has implied non-specific codes will not be permissible within ICD-10 claims.

    A physician who does not perform uncovered or medically unnecessary services only faces troublesome ICD-10 aftermath involving declining quality of care measures, concludes the Coalition. “The sole effect of a safe harbor will be to compromise the ability of Medicare to monitor quality of care,” the Coalition confirms. This result contradicts the transition from volume to value via the Sustainable Growth Rate (SGR) reform legislation, the Coalition confirms. As RevCycleIntelligence.com reported, ICD-10 delay language was indeed absent from the SGR Fix.

    Although the tangible implications of a proposed ICD-10 “grace period” are merely speculation, as future initiatives from Congress, the House, CMS, and others manifest themselves, it is hopeful physicians and healthcare providers will primarily reap financial benefits come October.