Seeks an 18-month Transition Out of Concern for Providers
Republicans introduced H.R. 2247, the Increasing Clarity for Doctors by Transitioning Effectively Now Act (ICD-TEN Act) on May 12, calling for an 18-month transition period following the implementation of ICD-10CM/PCS on October 1. During the transition period, the Centers for Medicare and Medicaid Services (CMS) would be also required to accept dual coding of claims – i.e., claims coded in either ICD-9 or ICD-10. Also during that period, CMS would be required to conduct “comprehensive, end-to-end testing” for the system, report to Congress on the functionality of the system, prove that the system was working, and not allow any denials to be made solely based upon the “use of an unspecified or inaccurate subcode.”
In a letter to fellow legislators urging them to co-sponsor the bill she authored, Rep. Diane Black (R-TN-6) argued that “we must ensure the transition does not unfairly cause burdens and risks to our providers, especially those serving Medicare patients… 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 was referred to the Committee on Energy and Commerce and the Committee on Ways and Means. Black serves on the Ways and Means Committee. At the time of this writing, the bill has three cosponsors, Rep. Andy Harris (R-MD-1), Rep. Larry Bucshon (R-IN-8) and Rep. David Poe (R-TN-1).
AHIMA Sides with CMS, Fears Fraud and Abuse
AHIMA officials have stated their decision to not support the bill since, in their opinion, CMS ICD-10 “contingency plans” are already in place, are working well, and AHIMA is convinced those plans will ensure an effective transition in October.
As an example, they cite CMS testing over 12 months that resulted in an 81 percent acceptance rate, and only three percent of rejected claims were due to invalid coding. Other claims were rejected because of errors unrelated to ICD-10. According to Margarita Valdez, senior director of congressional relations at AHIMA, and AHIMA CEO Lynne Thomas Gordon, CMS has done ample outreach and preparation, as supported by a recent Government Accountability Office report.
Also, Valdez and Gordon claim that CMS has indicated that it could grant “advance payments” to any physicians that do experience cash flow disruptions as a result of the ICD-10 transition, based upon its existing payment policies available when a provider incurs a temporary delay in its billing process causing financial difficulties for a provider. Valdez further suggested that the proposed transition period would “create an environment that’s ripe for fraud and abuse.”
What about Productivity?
All the testing being done by CMS, now or scheduled for the foreseeable future, is about “system functionality” with no regard given at all to productivity or its loss, which will, in this reporter’s opinion, be the ultimate issue. Not, will the system take the claim, but how many claims can the providers submit per day, in ICD-10? While estimates vary, we have seen experts predicting a 50% to 70% drop in coder productivity, at least in the beginning, after the October 1 changeover. Anecdotes about testing done by hospitals over the past year suggest that a coder previously coding 25 inpatient charts a day with ICD-9 may only be able to do eight charts a day with ICD-10. The math is not daunting, but the implications are indeed.
One might want to consider Canada’s transition to ICD-10-CA, which resulted in a 50% productivity loss. However, we should note that Canada doesn’t use ICD-10-PCS, nor does Canada use ICD-10 for reimbursement. Nevertheless, since we do use it that way in the U.S., it seems reasonable to close to that kind of productivity loss, or even worse. Also, keep in mind that neither Canada nor Australia ever returned to their pre–ICD-10 productivity levels.
Measures to Watch
Ultimately, several factors will contribute to the effects on productivity under ICD-10, including:
- Coder skill levels;
- Clinical Documentation Improvement (CDI) staff;
- Hospital case mix index and patient complexity;
- Coder education and practice time allotted; and
- Anything that is already affecting operations under ICD-9.
Also, it should not surprise any of our readers or listeners to Finally Friday! weekly webinars that we would also recommend the following considerations which can hugely affect productivity today, and even more so under ICD-10:
- Specificity and sufficiency of current documentation practices;
- Tracking, analysis and internal feedback loop for ALL audits and denials; and
- Evaluation and accountability for month-to-month progress in reducing audits and denials.