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Palmer Introduces Grace Period Bill To Help Doctors With New Medicare/Medicaid Coding System


By Brandon Moseley
Alabama Political Reporter 

Congressman Gary Palmer announced that on he has introduced legislation to protect patients from a complicated new coding system tied to Medicare and Medicaid called ICD-10.

U.S. Representative Palmer’s bill, H.R. 2652, The Protecting Patients and Physicians Against Coding Act, which was first introduced on June 4 would give physicians a two-year grace period in which they would not have Medicare and Medicaid reimbursements withheld if they or their staff made coding errors while documenting patient care.

Rep. Palmer said in a statement, “This legislation will help to ensure that doctors can continue to practice medicine and take care of their patients while also ensuring that patients will have access to healthcare services and their doctors during this period of transition.”  “Many medical practices are facing serious problems with the implementation of ICD-10 and we should act to ensure there is no disruption in patient care.”

Medical practices have until Oct. 1 to implement the changes. Palmer said this legislation is necessary because many smaller medical practices, particularly those in rural areas, are not ready to fully implement the complicated and time consuming new system and cannot afford to have their payment for services withheld because of coding errors.

ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO).  According to Wikipedia, the US uses the ICD-10 Procedure Coding System (ICD-10 PCS), a coding system that contains 76,000 codes not used by other countries.

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The deadline for the United States to begin using Clinical Modification ICD-10-CM for diagnosis coding and Procedure Coding System ICD-10-PCS for inpatient hospital procedure coding is set for October 1, 2015, but that has already been extended two years from the previous 2014 and 2013 deadlines.

Under ICD-10: characters 1-3 are f0r the category of the disease; 4 is for the etiology of the disease); 5 is for the body part affected), 6 is for the severity of the illness and 7 is just a placeholder for extension of the code to increase specificity.  Get the code wrong and the doctor’s office is not going to get paid by Medicare or Medicaid.  Medical providers are having to switch over from the old ICD-9 codes which requires new software and on the job training for doctors, nurses, staff, and administrators.

The American Medical Association (AMA) said in a 2014 letter to then U.S. Department of Health and Humans Services (HHS) Secretary Kathleen Sebelius that, “Adopting ICD-10, while it may provide benefits to others in the healthcare system, is unlikely to improve the care physicians provide their patients and takes valuable resources away from implementing delivery reforms and health information technology.”

The AMA stated that ICD-10 is, “One of the largest business, operational and technical implementations that the healthcare industry has undertaken in several decades — and it appears to be among the priciest.  Whereas in 2008 the projected cost of compliance topped out at approximately $84,000 for small practices, that range now opened to $225,000; for mid-size practices it stepped from $285,000 up to $825,000; and some large practices may plunk down more than $8 million to meet the ICD-10 mandate instead of the formerly anticipated $2 million ticket.”

In a normal business, the healthcare providers could just pass on the cost of government regulations compliance to its customers.  Not so in healthcare where the government, in Medicare and Medicaid, is also the payer.  Hospitals and doctors are forced to accept payment in the amount that CMS dictates the payment to be.  The federal government pays well over half of the healthcare dollars spent in this country.  Healthcare providers have to absorb all the costs of switching over to ICD-10 from cutting profits, cutting other costs, or by somehow increasing the volume of business that they do.

Congressman Gary Palmer represents Alabama’s Sixth Congressional District where many residents work in the healthcare care sector.

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Brandon Moseley
Written By

Brandon Moseley is a senior reporter with over nine years at Alabama Political Reporter. During that time he has written 8,297 articles for APR. You can email him at [email protected] or follow him on Facebook. Brandon is a native of Moody, Alabama, a graduate of Auburn University, and a seventh generation Alabamian.