ICD-TEN Act reasonable and responsible

In healthcare, far-reaching policy decisions require great caution and thoughtful administration. Indeed, not only are budget lines at stake in the midst of sweeping change, but also the health and wellbeing of our nation’s most vulnerable patients.

This October, the federal government will implement such an overhaul in medical coding, as physicians will be required to make the change from ICD-9 to the updated ICD-10. As a doctor myself, I clearly understand the merits of the new, more efficient coding set. However, there is a growing sense among many of my colleagues — both healthcare professions and those in the health policy world — that a hasty transition will lead to billing errors, risking non-payment for providers and threatening care consistency.

{mosads}Therefore, as we approach the deadline for ICD-10, a reasonable and responsible implementation plan is essential for the viability of our nation’s small and rural practices, continued access to care for our patients and the integrity of the Medicare program. While a number of legislative solutions have now been offered up in Congress, Representative Diane Black’s Increasing Clarity for Doctors by Transitioning Effectively Now (ICD-TEN) Act, H.R. 2247, is a commonsense approach that most effectively addresses systematic concerns.

The ICD-TEN Act would establish an 18-month “safe harbor” period in which sub-code errors cannot become the basis for rejection of claims. As the ICD update will effectively quadruple the current number of diagnosis and medical billing codes, the 18-month transition period will serve as a reasonable time for practices to adjust to new coding sets. Importantly, the timeline will also incentivize providers to make a timely transition to ICD-10, while protecting both taxpayers and Medicare from exploitative practices. 

In this way the ICD-TEN Act is unique among seemingly similar transition-based legislation because it does not ensure blanket immunity for any error. Instead, it protects physicians from billing errors exclusively in sub codes, which are used primarily for disease tracking and treatment, and not for payment purposes. In rheumatology, for instance, a sub code error could mean the difference between denoting arthritis treatment in the right or left hand. Minor sub-code errors like these are bound to happen as physicians learn the expanded code set, but they should not be a reason to deny payment for services rendered. Under the ICD-TEN Act, the main diagnostic codes used for payment purposes would still need to be correct in order to receive payment. By making this distinction, the legislation strikes an important balance in protecting providers against nonpayment due to honest errors, while protecting the system against fraud or abuse.

Ultimately, physicians — the majority of which would never intentionally engage in dishonest practices — will not be held responsible for their small missteps as they learn a new, complex system. But those few who make gross billing errors, which could result in thousands of dollars in misdirected physician payments, will not be excused, unlike in alternate legislative proposals. This is smart, sensible policy at its best.

Moreover, H.R. 2247 is careful to address claims payment specifically, which leads to more accurate data collection. This provision is crucial because one of the most important implications of ICD-10 is the advancement of public health knowledge. With more precise information regarding how we treat patients and which treatments work best, researchers and doctors can together contribute to improved care and patient outcomes. 

In addition to better aligning incentives and improving public health knowledge, the ICD-TEN Act is the only proposed, bipartisan legislation that will also help ensure that any “kinks” in the system are ironed out before full implementation takes place. In fact, the legislation requires comprehensive end-to-end testing of the ICD-10 system prior to Oct. 1 implementation date.

With history serving as a guide, it is clear that careful execution of major technological rollouts — especially in healthcare — can truly be the key to success. The ICD-TEN Act promises the judicious administration that a coding overhaul of this magnitude requires, and the American people and their healthcare providers deserve.

While there are several legislative proposals seeking to address the imminence of ICD-10 implementation, Rep. Black’s (R-Tenn.) is the most reasonable and responsible approach. Only the ICD-TEN Act can protect our nation’s caretakers while facilitating a much-needed elevation of our healthcare coding system. I encourage our nation’s lawmakers to support this common-sense legislation.

Harvey is a practicing rheumatologist and chairman of the American College of Rheumatology Government Affairs Committee.