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Rheumatology Community Issues Six Myths and Facts About Bipartisan ICD‐TEN Act “Safe Harbor” Legislation

ATLANTA, Ga. – The American College of Rheumatology (ACR) today issued a policy resource, “Six Myths and Facts about the ICD‐TEN Act,” intended to correct misinformation about the bill’s safe harbor provision. The ICD‐TEN Act (H.R. 2247) is a bill recently introduced by Representative Diane Black (R‐TN) that has bipartisan support among U.S. lawmakers and would ensure a reasonable and responsible transition to ICD‐10. As the U.S. healthcare system transitions from the current ICD‐9 medical coding set to the updated ICD‐10 system, the legislation would institute an 18‐month “safe harbor” period after the October 1, 2015 implementation date, during which time physicians would not be financially penalized for minor mistakes due to sub‐coding errors.

An important distinction between the ICD‐TEN Act and other proposed ICD‐10 legislation is that the safe harbor provision in H.R. 2247 would only apply to minor sub‐coding errors made during the 18‐ month transition. The safe harbor provision would not provide blanket immunity for errors made to the base diagnosis codes – the codes currently used for payment purposes.

“Sub‐codes most often indicate subtypes or locations of disease. While this specificity is beneficial for disease surveillance and some treatment decisions, it is not relevant to determination of coverage or medical necessity, and should not be used to deny payment for services rendered,” said Dr. William Harvey, a practicing rheumatologist and chair of the ACR Government Affairs Committee. “The ICD‐TEN Act is carefully worded to allow Medicare to continue to accurately determine medical coverage and medical necessity using the new base ICD‐10 diagnosis codes,” continued Harvey.

Other myths addressed in the policy resource include:

  • Myth: Safe harbor raises serious fraud and abuse concerns. FACT: The ICD-TEN Act does not provide blanket immunity for any error.
  • Myth: Safe harbor encourages incomplete documentation—a quality of care issue. FACT: The ICD-TEN Act’s safe harbor provision ensures that coding specificity is achieved without disrupting patient care.
  • Myth: Safe harbor is just another delay by a different name. FACT: Under the ICD-TEN Act safe harbor period, ICD-10 moves forward on October 1 as scheduled.

If passed into law, the ICD‐TEN Act would also require that the Centers for Medicare & Medicaid Services (CMS) conduct full end‐to‐end testing prior to the transition and certify to Congress that the Medicare fee‐for‐service claims processing system based on the ICD‐10 standard is fully functioning.

The bill does not allow dual‐coding or the continued submission of ICD‐9 codes.

“The ICD‐TEN Act is a reasonable compromise that represents a middle ground between those who want to delay or eliminate ICD‐10 altogether, those who have been pushing for no further delays – including groups that stand to benefit financially from ICD‐10 – and the many U.S. providers who want to see ICD‐10 go forward in a responsible way without negatively impacting physician practices and the patients under their care,” concluded Harvey. “The American College of Rheumatology fully supports the ICD‐TEN Act as a common‐sense, bipartisan solution, and we encourage other healthcare providers and policymakers to do the same.”

Jocelyn Givens
404-633‐3777, ext. 810

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The American College of Rheumatology is an international medical society representing over 9,400 rheumatologists and rheumatology health professionals with a mission to Advance Rheumatology! In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases. For more information, visit www.rheumatology.org.

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