Physician leaders from three states have joined the Texas Medical Association in asking the federal government to help doctors dodge disaster by adopting a two-year, penalty-free grace period to shift to the new ICD-10 medical billing and coding system. The four largest state medical associations — from Texas, California, Florida, and New York — sent a letter to Andy Slavitt, acting administrator for the Centers for Medicare & Medicaid Services (CMS), which will roll out the mandatory shift to ICD-10 on Oct. 1.
David Henkes, MD, of San Antonio, chair of the Texas Delegation to the AMA House of Delegates, signed on behalf of TMA.
And CMS leaders are listening. Last week, the agency arranged a conference call for physicians and staff from the four states to further explain their request. TMA President Tom Garcia, MD, and Asa Lockhart, MD, vice chair of the Texas Delegation to the American Medical Association House of Delegates, represented Texas on the call.
The letter supports the AMA house's recent passage of a resolution calling for CMS to establish the two-year ICD-10 grace period.
"The Oct. 1 mandatory implementation of the ICD-10 coding system is a looming disaster," the letter to Mr. Slavitt explains.
Dr. Henkes and the other letter authors call for:
- A two-year period during which physicians will not be penalized for errors, mistakes, and/or malfunctions of the system;
- A two-year period in which physicians will not be subject to special Medicare-payment audits due to ICD-10 coding mistakes;
- A two-year period during which physician payments will not be reduced or withheld based on ICD-10 coding mistakes; and
- Advance payments in the event of claims delay.
The problem with ICD-10, physicians say, is the alarming size of the change: ICD-9, adopted in the 1970s, has 13,500 codes, while ICD-10 has 69,000. The codes are very specific. And omitting a detail could lead to a penalty. Physicians have been preparing for years to make the transition by training themselves and their office staffs, learning the new codes, and ensuring their electronic health records (EHRs) system can accommodate the huge change.
Many describe it as an expensive government-mandated headache. "Even those practices that are most prepared for this transition tell us they worry about the confusion and reduced productivity they expect to accompany ICD-10," the letter says. "The quite realistic prospect of reams of denied and significantly delayed claims raises the specter of financial disaster or bankruptcy for many small practices."
If physicians or their staffs miscode or are not specific enough, their practice could face penalties or payment delays for care they already provided. Physicians want the grace period to smoothly transition to the new system without penalty for simple mistakes.
"We believe that two years of transition time, on-the-job learning by physicians — plus our continued ICD-10 educational activities — will result in a much less disastrous transition to this overwhelmingly complicated new coding system," say the doctors.
Short of that, physicians fear disruptions and delays in patient care. They point to recent government tests assessing ICD-10 readiness of all the players involved, which revealed errors. Claim acceptance rates ranged from 76 percent to 89 percent in the CMS "end-to-end" ICD-10 tests. The rest of the claims were rejected for myriad reasons.
Doctors add that even if one of the other links in the code-reporting chain, like EHR vendors, isn't ready by October, physicians and their patients will suffer. And the government's demands are not fairly distributed; for example, EHR, practice management, and billing companies do not have to complete software upgrades until Oct. 1 — the same day doctors must start reporting via the new system. That leaves physician practices no time to adapt to software changes before they must report patient records via ICD-10 codes.
Physicians expect disruptions in patient care and reduced productivity that could cost their practices hundreds of thousands of dollars and extend patient waiting times. TMA and the other participating state medical societies are asking physician members to write Congress to ask senators and representatives to push CMS to stop or postpone the ICD-10 implementation or — at the very least — to enact the grace period.
TMA also joined with the medical societies from California, Florida, and New York in a letter asking the leaders of the U.S. Congress to stop the Oct. 1 implementation of the ICD-10 coding system or require CMS to establish a two-year, penalty-free grace period for physicians.
"We remain steadfast in our belief that the ICD-10 coding system offers no real advantages to physicians and our patients — and certainly no advantages to justify the time and expense the entire health care system has invested in this transition," TMA and the medical societies wrote, pushing them to pass HR 2126, the Cutting Costly Codes Act of 2015, by U.S. Rep. Ted Poe (R-Houston).
"If these requests are not achievable, we strongly encourage you to pass legislation such as HR 2652, the Protecting Patients and Physicians Against Coding Act, by Congressman Gary Palmer (R-Alabama) and others, or simply join our call for CMS to implement a two-year ICD-10 grace period," the letter states.
In addition, health professionals have until July 10 to take an ICD-10 readiness survey
from the Workgroup for Electronic Data Interchange (WEDI). Results will help to determine how well the health care industry is progressing toward the Oct. 1 implementation deadline. WEDI will evaluate and compile the results into a report for the industry.
Action, July 1, 2015
A recent U.S. Office of Inspector General (OIG) fraud alert warns that physician compensation arrangements may result in significant liability.
"Physicians who enter into compensation arrangements such as medical directorships must ensure that those arrangements reflect fair market value for bona fide services the physicians actually provide," the alert states. "Although many compensation arrangements are legitimate, a compensation arrangement may violate the anti-kickback statute if even one purpose of the arrangement is to compensate a physician for his or her past or future referrals of federal health care program business. OIG encourages physicians to carefully consider the terms and conditions of medical directorships and other compensation arrangements before entering into them."
OIG recently reached settlements with 12 physicians who entered into "questionable medical directorship and office staff arrangements."
In the alert, OIG adds that "those who commit fraud involving federal health care programs are subject to possible criminal, civil, and administrative sanctions." OIG has more information on physician relationships:
Action, July 1, 2015