Health Information Management

The inevitability of ICD-10 is slowly dawning on Congress

APCs Insider, May 15, 2015

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By Steven Andrews
As Congress' latest attempt to delay, or permanently derail, ICD-10 languishes in committees with no new cosponsors, it appears some members are finally recognizing the inevitability of ICD-10.
On May 12, Rep. Diane Black, R-Tennessee, introduced H.R. 2247, the Increasing Clarity for Doctors by Transitioning Effectively Now Act (ICD-TEN Act), calling for no delay to ICD-10 implementation, but instead open end-to-end testing by CMS for 18 months in order to assess its fee-for-service claims processing. Apparently, the bill will not affect facility payments to prospective payment systems.
Congress isn't just coming up with better acronyms for its ICD-10-related bills, it may also finally be acknowledging that repeated delays have done nothing but increase costs for the transition and lead to a lack of buy-in due to uncertainty.
After the 18 month testing period, CMS would have to prove that claims processing is fully functioning and it approved at least as many ICD-10 claims as it did the previous year in ICD-9. This isn't a bad idea, and it's the most reasonable response yet from Congress on how to ensure a smooth ICD-10 transition.
But the bill would also instruct CMS that during the 18 month period, no claims could be denied solely due to unspecified codes or "inaccurate subcodes," according to the bill.  
We've already seen one successful round of ICD-10 testing from CMS, with results from the most recent round expected soon and another planned for the summer. The industry, and the government, should have plenty of information by then to determine whether we’re ready for ICD-10.
Ultimately, this bill would only give providers who refuse to accept ICD-10 another reason to delay learning the specifics. One of the major issues Congress had with ICD-10 during a February hearing was the lack of immediate impact from data collected due to the code set's new specificity. If providers don't have to worry about documenting that specificity for another 18 months, we're just delaying one of the advantages of switching.
Even though it's a more reasonable approach, this bill will likely face the same fate as all other standalone ICD-10 bills introduced in Congress over the years and die without a vote. Currently, the bill has just three cosponsors and no bipartisan support.

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