Health Information Management

Latest ICD-10 bill shows AMA, Congress flailing to find a way out of implementation

HIM-HIPAA Insider, June 22, 2015

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The AMA and Republican congressmen have been working together for quite a while to try and kill ICD-10, but their latest attempt shows not only desperation, but a fundamental misunderstanding of how coding works.
 
At its annual meeting Sunday, June 7, the AMA’s House of Delegates began a divisive discussion about ICD-10, according to MedPage Today. The Oklahoma delegation reportedly brought a resolution calling for physicians nationwide to simply boycott ICD-10, a proposal so outlandish and dangerous that the House of Delegates didn’t even allow it to be debated or discussed for fear of legal action from the Federal Trade Commission.
 
The group finally found consensus on a resolution for the Delegation to vote this week regarding a two-year grace period during which providers cannot be penalized for mistakes in ICD-10 code reporting. William Jefferson Terry, MD, proposed the resolution.
 
You might remember Terry, a representative of the American Urological Association (AUA), as the only voice of dissent among witnesses during February’s House of Representatives hearing on ICD-10. He memorably complained that ICD-10 was too confusing and too extensive for physicians to ever adapt to—until another witness pointed out that the AUA had lobbied for 200 new codes for its specialty in the first ICD-10 update.
 
Terry’s resolution goes so far as to ask the AMA to find a way for physicians to opt out of contracts with Medicare and all other payers after implementation if they cannot figure out the codes, MedPage Today reports.
 
This idea of a two-year grace period didn’t just come from Terry’s mind—it’s clearly another part of a concerted effort with Republican congressmen to kill ICD-10. Last week, before Terry’s proposal was made, Rep. Gary Palmer, a Republican from Terry’s home state of Alabama, introduced H.R. 2652, the Protecting Patients and Physicians Against Coding Act of 2015.
 
The bill calls for a two-year grace period during which providers submitting claims with ICD-10 codes “are not penalized for errors, mistakes, and malfunctions relating to the transition.” In other words, forget about laterality, tracking episodes of care, or any other specificity you’ve spent years learning.
 
If it weren’t so dismissive to all the coders, providers, and health system that have spent so much time and money learning ICD-10 in order to prepare for the government’s mandate, this bill would almost be comical. By not holding providers accountable for ICD-10 codes, the government opens itself up to a Wild West atmosphere in which claims have no bearing on the actual treatment offered at best and massive fraud at worst.
 
According to the Office of Management and Budget, Medicare accounts for nearly $46 billion in annual improper payments today—that number would undoubtedly skyrocket if CMS did not require accurate diagnosis codes.
 
The bill also calls for the government to aid physicians with learning ICD-10 and the Government Accountability Office (GAO) to study whether such efforts were effective. No, that’s not déjà vu you’re experiencing, this is the same exact study the GAO already completed and reported to Congress earlier this year.
 
That study found CMS’ extensive efforts to educate providers to be adequate and encouraged testing efforts, such as the two successful recent rounds of end-to-end testing. The study also cited stakeholders who noted that delay efforts, largely led by the AMA, have been very damaging and costly to the industry.
 
Finally, the bill calls for the GAO to study the effect of ICD-10 on the industry and report back no later than April 1, 2016. That’s right, in less than six months during which ICD-10 codes do not matter at all, Palmer expects a study to decisively determine their impact on providers.
 
If this all sounds crazy to you—coders who have spent years learning ICD-10 and ready for the transition—it should. It’s an obviously desperate ploy for the AMA to appeal to its members and congressmen to justify the massive donations they get from the healthcare industry. Would it surprise you to learn a medical society was the largest outside donor, by far, to Palmer’s recent campaign?
 
So does this mean it’s time to forget everything you’ve learned and just prepare to just apply approximate ICD-10 codes for the next two years? I don’t think so. Despite having 35 cosponsors—all Republican—Palmer’s bill is competing with two other ICD-10 bills. Even if all of the representatives who introduced those bills joined forces, it’d still be a very partisan uphill battle to get an individual bill through Congress. With the Sustainable Growth Rate out of the way, Congress doesn’t have any other major healthcare bills to attach these to.
 
What Terry, the AMA, and Congress seem to forget is that the industry has had plenty of time (six years, to be exact) to prepare for this transition. These bills and debates only let providers think they can push off efforts and do more damage than good. Congress doesn’t need to protect patients and physicians against codes—they just need to get out of the way.
 

This article originally appeared on HCPro’s ICD-10 Trainer blog.



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