AMA lobbies for 2 year grace period that payers should not be allowed to deny payments to physicians for ICD-10 coding errors.
This week, The American Medical Association (AMA) policymaking House of Delegates held its annual meeting with ICD-10 as one of their key concerns. In the meeting, the delegates voted that the AMA should lobby Congress and Medicare to require health insurers to give physicians flexibility for the first 2 years after the ICD-10 compliance date of October 2014.
During this proposed grace period, payers should not be allowed to deny payments to physicians for all ICD-10 coding errors and should be required to provide feedback on why claims were denied. According to coding experts, nearly 65% of clinical documentation does not contain enough information for coders to use for billing, which further complicates the ICD-10 transition since most doctors do not provide enough detail for office coders to translate that to ICD-10.
Physicians commonly use unspecified codes when they do not know how to exactly diagnose a patient. It has been reported at this time that payers will not reimburse for unspecified codes.
Dual coding is another key concern for physicians as ICD-10 only applies to patients covered under HIPAA, so Workers Compensation patients will still be billed under ICD-9.
There are currently no plans for extensions according to ONC Chief Farzad Mostashari, MD who delivered the keynote speech this week at the HIMSS Media ICD-10 Forum in National Harbor, MD.
“The current extension, from Oct. 1, 2013 to Oct. 1, 2014 was partly due to looking at the incremental changes needed in reforming healthcare, and realizing that “sometimes, extensions are needed,” Mostashari said
The extension also allowed the National Library of Medicine to do a detailed crosswalk between SNOMED and ICD-10 that will help physicians find the right code and enable the physician to share only what is needed with the physician or hospital’s billing department.
Despite the positive benefits of ICD-10, the AMA plans to continue its push against ICD-10 and go directly to ICD-11.