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Heritage Foundation wants ICD-10 delay, pushes for new billing process

Nonprofit says rollout should be voluntary and dual coding allowed.

Susan Morse, Senior Editor

"Instead of imposing this unfunded mandate, Congress should delink the disease classification system from reimbursement policy, and make the adoption of the new ICD-10 code system voluntary until a less burdensome billing process is in place," The Heritage Foundation wrote in a May 18 report."Instead of imposing this unfunded mandate, Congress should delink the disease classification system from reimbursement policy, and make the adoption of the new ICD-10 code system voluntary until a less burdensome billing process is in place," The Heritage Foundation wrote in a May 18 report.

Nonprofit conservative think tank the Heritage Foundation also believes ICD-10 should be delayed, adding its voice to growing opposition against the scheduled Oct. 1 rollout of the diagnostic coding vocabulary.

The American Medical Association and at least two U.S. Representatives are already calling for Congress to rethink launching ICD-10.

[Also: AMA chief says US should wait for ICD-11]

“Instead of imposing this unfunded mandate, Congress should delink the disease classification system from reimbursement policy, and make the adoption of the new ICD-10 code system voluntary until a less burdensome billing process is in place,” The Heritage Foundation wrote in the May 18 report.

The Heritage Foundation also recommends Congress enable dual-coding without penalty for those using ICD-9.

Last week, incoming AMA President Steve Stack called for Congress to abandon ICD-10, in favor of waiting for the next International Classification of Diseases in ICD-11, scheduled to come out in draft form in 2017.

The Heritage Foundation makes no mention of ICD-11, recommending instead that the U.S. “develop a more appropriate coding system that makes the billing process less, not more, burdensome."

Two House bills call for a delay or transition “hold harmless” period for ICD-10. Neither is expected to make it out of committee.

[Also: ICD-10 bill surfaces, calls for delay]

It seems more likely the United States will flip the switch to ICD-10 on Oct. 1 as planned.

Many providers – more hospitals than physician practices - have said they are ready for ICD-10, which will increase the number of medical diagnostic codes from the current 14,000 to an estimated 68,000. All providers who transmit health information electronically must use the ICD-10 after the Oct. 1 to be reimbursed for their services.

Incorrect diagnostic codes are a common reason for payers to deny a claim.

Claims-error rates are expected to climb more than twofold with ICD-10, reaching as high as 6 percent to 10 percent of all claims, according to The Heritage Foundation report, quoting figures from the Healthcare Information and Management System Society, the parent company of Healthcare Finance News.

[Also: New ICD-10 bill asks for transition period, but not a delay]

Also, Heritage cites an analysis by Fitch Ratings detailing how reimbursement disruptions triggered by ICD-10 will hurt the credit rankings for hospitals, making it much more difficult for them to acquire loans with affordable interest.

Last year the Heritage Foundation recommended delaying the ICD-10 coding system.

Addressing the claim that other developed nations have long adopted ICD-10, Heritage said only 10 use it in the reimbursement process and six of those have a single-payer healthcare system.

Heritage also counters the argument that ICD-10 improves patient care, saying there are better ways to retrieve data.

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Within three years, Congress should establish an alternative arrangement for reimbursement that is separate from the ICD disease classification system, The Heritage Foundation recommends.

At the end of the three-year period, providers using ICD-9, as well as those using ICD-10 for reimbursement, would transition to the new billing system. If a more appropriate system can be developed before the end of this period, providers would have the option of adopting that system when it becomes available, it stated.

Twitter: @SusanMorseHFN

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