George Breen Quoted in “As ICD-10 Approaches, Providers Face Opportunities and Obstacles”

Health Care Fraud Report

George B. Breen, a Member of the Firm in the Health Care and Life Sciences and Litigation practices and Chair of the firm's National Health Care and Life Sciences Practice Steering Committee, was quoted in Bloomberg BNA’s Health Care Fraud Report, in “As ICD-10 Approaches, Providers Face Opportunities and Obstacles,” by James Swann.

Following is an excerpt:

George B. Breen, an attorney with Epstein Becker & Green in Washington, told Bloomberg BNA that providers have several concerns about ICD-10, including how it will affect their reimbursements.

For example, Breen said end-to-end testing for the ICD-10 transition conducted in January by the Centers for Medicare and Medicaid had a 19 percent error rate, meaning the claims were rejected that often.

“There’s concerns that ICD-10 could lead to significant reimbursement delays and denials, which could result in cash-flow problems,” Breen said.

Health-care professionals are also going to have differences over what constitutes the correct diagnosis code under ICD-10, Breen said, which might also negatively impact reimbursement. …

Breen said providers are also worries about how ICD-10 coding will be used by program integrity contractors.

“Will they be used by audit contractors looking at fraud and abuse issues,” Breen said. …

“Your compliance program needs to anticipate ICD-10,” Breen said. “Make sure your internal audits are prepared to assess ICD-10 codes, and make sure you’ve rained both professional and non-professional staff.”