On July 6, the Centers for Medicare & Medicaid Services (CMS) announced that for one year after Oct. 1, 2015, it will not deny claims on the basis of incorrect ICD-10 sub-codes, so long as the correct family of codes is used. CMS further stated that it will not penalize those reporting for quality programs if CMS has problems calculating quality scores because of the new codes. CMS will create an ICD-10 ombudsman to help providers with problems during implementation. And lastly, it will authorize advance payments if a claims processing problem of extended duration occurs.
Those of you following this issue will recall that the ACR has been fighting for these provisions for quite some time. We’ve employed a large number of strategies, which include writing op-eds (one of which was recently posted on The Hill) and letters to CMS and Congress; supporting American Medical Association (AMA) resolutions that mirrored our language; and most importantly, drafting legislation to force CMS to act.
On May 12, that legislation, ICD-TEN Act (HR 2247), was introduced to Congress by Rep. Diane Black (R-TN6). It calls for comprehensive testing with contingency plans if problems with processing are expected. It also calls for an 18-month implementation period during which claims shall not be denied due to errors in sub-codes. In short, CMS has pledged to administratively enact, almost verbatim, our bill. It even went a step further with the quality program concessions.
Of course, that was the whole point. This is another wonderful accomplishment with a few caveats.
This approach is not a full delay. The ACR has supported a full delay in the past, but sought this current avenue of approach as a reasonable alternative to delay with a greater chance of success. Also, this is not the 18 months we asked for. Your advocacy team will work to see how we can modify CMS’ decision or put in place other protections. Last, this affects only CMS (i.e., Medicare), not the private market. We continue to work on ways to get the same type of protections there if this coding system has to go forward.
In summary, ACR members have been vocal about their opposition to ICD-10, and the ACR has responded, playing a key role—not once, but twice—in mitigating the impact of ICD-10 on our membership. We used every tool in the toolbox. The GAC and CORC strategy was fueled by RheumPAC to create productive meetings with key legislators who wrote to CMS on our behalf and introduced our language to CMS and Congress. Our ACR staff and public relations team have been peppering Congress and the media about this issue. Our lobbyists have been making their way across The Hill, having meetings with key people. And once more, we have overcome a massive, rich and vocal counter-advocacy campaign by those who stand to make the most money from the transition. Although we are small, if we work hard and work together, we can continue to accomplish important things for our members and our patients.