The Centers for Medicare & Medicaid Services must make an ICD-10 contingency plan for how Medicare will process claims if on the implementation date--Oct. 1--the agency is unable to process the new codes, House lawmakers say in a letter to Acting Administrator Andy Slavitt.
In addition, the legislators--who include Reps. Kevin Brady (R-Texas), Sam Johnson (R-Texas) and Tom Price (R-Ga.) and 10 others--ask that CMS:
- Indicate whether claims need to have the ICD-10 code with the highest level of specificity on Oct. 1 or if a less granular code would be OK
- Create a description for the public of how the new codes will be used for incentive payment program for reporting on quality of care and how they will be incorporated into anti-fraud efforts
- Offer end-to-end testing to providers beyond the 2,500 currently eligible for the testing. There should be emphasis on helping smaller providers, who have struggled the most with the transition.
- Inform providers about resources available to prevent claims processing disruption in the event they can't submit ICD-10 codes.
"Providers need to be aware that fallback options are available if they experience problems with their billing systems," the lawmakers write. "CMS needs to use the tools at its disposal to ensure a smooth transition to the new coding system. Using those tools in a transparent manned with help to avoid provider cash flow problems that could lend to patient care disruptions."
Lawmakers have entrenched themselves in the debate over ICD-10.
A House bill, introduced by Rep. Diane Black (R-Tenn.)--who also signed the letter to Slavitt--would require end-to-end testing of the transition from ICD-9 to ICD-10 by the Health and Human Services Department, and would provide an 18-month transition period to the new code set.
In addition, Rep. Ted Poe (R-Texas) introduced legislation that would ban outright the use of the code set.
CMS announced Tuesday that 88 percent of test claims were accepted during its second round of ICD-10 testing in April. That compares with an 81 percent acceptance rate from the first round of testing, which began in January.
To learn more:
- read the letter (.pdf)