CMS Grace Period Falls Short - Private Insurances Left Unaddressed

SILICON VALLEY, Calif.--(BUSINESS WIRE)-- In response to the recent ICD-10 policy update by The Centers for Medicare & Medicaid, software maker PracticeSuite, Inc. says that the new plan although good, falls short of providing a complete safeguard for medical practices in that it fails to address Private Insurances:

In a petition to the White House posted on its corporate website, the software maker urges President Obama to mandate a reimbursement contingency plan for all health benefit payers, to prevent disruption of payments during the transition to the new ICD-10 coding system.

About 80% of a “typical” practice’s revenue is paid in-arrears via insurance reimbursements, sometimes long after medical treatment has been rendered. Roughly 40% of these medical claims are from “commercial” or private health plans. So the recent win by the AMA of a twelve month grace period of coding leniency from CMS safeguards only about half of a practice’s revenue.

“The CMS decision is good, but solves only half the problem,” states PracticeSuite’s CEO Vinod Nair. “Thousands of profit driven private insurances are going to need more direction than just looking to CMS as an example.”

“If we’re to avoid inevitable disruption in payments, the contingency must be universal, applicable to all payers,” states Mr. Nair.

Some insurance payers are avowedly still unable to process ICD-10 claims, which means doctors will have to produce two versions of claims for the foreseeable future if they want to get reimbursed. CMS processes a billion claims a year from 1.6 million providers and completes its final testing today. Its previous testing included 875 participants and tested 23,138 claims. “This small sample of the most prepared in no way represents the readiness of the larger payer/provider community,” states Nair.

The question of the hour is who will require an entire industry to protect its weakest links – patients and the small medical businesses that serve them?

“Now that CMS has stated a clear and strong contingency policy, we are calling on all physicians to support the petition asking President Obama to make it applicable to all payers,” states Nair.

Read and sign the petitionhttp://www.practicesuite.com/ICD-10/petition-to-mitigate-the-impact-of-icd10Is New Bill Strong Enough to Fight ICD-10 Meltdownhttps://www.linkedin.com/pulse/new-bill-strong-enough-fight-icd-10-practicesuite-inc-pm-rcm-ehrEmbedded Video Available: https://www.youtube.com/watch?v=Tzelf2WzcC4

View source version on businesswire.com: http://www.businesswire.com/news/home/20150724005818/en/

PracticeSuite
Michael Sculley, 510-284-2425
VP Marketing
Msculley {at} practicesuite.com

Source: PracticeSuite

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