I 

114TH CONGRESS 

1ST SESSION H. R. 2247 

To require the Secretary of Health and Human Services to provide for 

transparent testing to assess the transition under the Medicare feefor-service claims processing system from the ICD–9 to the ICD–10 

standard, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 12, 2015 

Mrs. BLACK (for herself and Mr. HARRIS) introduced the following bill; which 

was referred to the Committee on Energy and Commerce, and in addition 

to the Committee on Ways and Means, for a period to be subsequently 

determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To require the Secretary of Health and Human Services 

to provide for transparent testing to assess the transition 

under the Medicare fee-for-service claims processing system from the ICD–9 to the ICD–10 standard, and for 

other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Increasing Clarity for 

5 Doctors by Transitioning Effectively Now Act’’ or the 

6 ‘‘ICD-TEN Act’’. 


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1 SEC. 2. IMPLEMENTATION OF HIPAA CODE SET STAND2 ARDS. 

3 The Secretary of Health and Human Services shall 

4 implement, administer, and enforce, in accordance with 

5 this Act and consistent with section 212 of the Protecting 

6 Access to Medicare Act of 2014, the regulations issued 

7 on January 16, 2009 (74 Fed. Reg. 3328) and on Sep8 tember 5, 2012 (77 Fed. Reg. 54664) that provide for 

9 the replacement of ICD–9 with ICD–10 as a standard for 

10 code sets under section 1173(c) of the Social Security Act 

11 (42 U.S.C. 1320d–2(c)) and section 162.1002 of title 45, 

12 Code of Federal Regulations. 

13 SEC. 3. COMPREHENSIVE TESTING. 

14 (a) IN GENERAL.—The Secretary of Health and 

15 Human Services shall conduct a comprehensive, end-to16 end testing process to assess whether the Medicare fee17 for-service claims processing system based on the ICD– 

18 10 standard is fully functioning. 

19 (b) AVAILABILITY.—The Secretary shall make the 

20 end-to-end testing process available to all providers of 

21 services and suppliers (as defined under subsections (u) 

22 and (d), respectively, of section 1861 of the Social Secu23 rity Act (42 U.S.C. 1395x) participating in the Medicare 

24 fee-for-service program under parts A and B of title XVIII 

25 of such Act (42 U.S.C. 1395c et seq.). 

26 (c) CERTIFICATION.— 


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1 (1) IN GENERAL.—Not later than 30 days after 

2 the date of completion of the end-to-end testing 

3 process, the Secretary shall submit to Congress a 

4 certification on whether or not the Medicare fee-for5 service claims processing system based on the ICD– 

6 10 standard is fully functioning. 

7 (2) ADDITIONAL STEPS IN CASE STANDARD IS

8 NOT FULLY FUNCTIONING.—In the case that the 

9 Secretary certifies under paragraph (1) that such 

10 processing system based on the ICD–10 standard is 

11 not fully functioning, the Secretary shall include in 

12 the submission to Congress under paragraph (1) ad13 ditional steps that will be taken to achieve a certifi14 cation that such processing system based on such 

15 standard is fully functioning and the anticipated 

16 timeframe for achieving such certification. 

17 (d) DEFINITIONS.—In this Act: 

18 (1) END-TO-END TESTING PROCESS.—The term 

19 ‘‘end-to-end testing process’’ means an process de20 signed to demonstrate that— 

21 (A) submission of claims to the Secretary 

22 with ICD–10 codes and the receipt of a remit23 tance advice can be accomplished on a routine 

24 basis at high volume levels; 


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1 (B) any software changes made to support 

2 the ICD–10 standard result in appropriately 

3 adjudicated claims; 

4 (C) accurate remittance advices are pro5 duced; and 

6 (D) all phases of the implementation of the 

7 ICD–10 transition are operable. 

8 (2) FULLY FUNCTIONING.—The term ‘‘fully 

9 functioning’’ means, with respect to the period of the 

10 end-to-end testing process of the Medicare fee-for11 service claims processing system based on the ICD– 

12 10 standard, that the percentage of claims accepted 

13 under such system so based during such period is 

14 equal to or greater than the percentage of claims ac15 cepted during the calendar year previous to such pe16 riod, based on the ICD–9 standard. 

17 SEC. 4. IMPLEMENTATION PERIOD. 

18 (a) IN GENERAL.—The implementation period during 

19 which the transition to ICD–10 standards shall be made 

20 shall begin on October 1, 2015, and end on the date that 

21 is 18 months after the date on which a certification is 

22 made under section 2(c) that the Medicare-fee-for service 

23 claims processing system based on the ICD–10 standard 

24 is fully functioning. 


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1 (b) SAFE HARBOR.—During the implementation pe2 riod described in subsection (a), no claim submitted for 

3 payment under title XVIII of the Social Security Act by 

4 a health care provider pursuant to the ICD–10 standard 

5 medical data code sets shall be denied due solely to the 

6 use of an unspecified or inaccurate subcode. 

7 (c) ASSISTANCE.—During the implementation period 

8 described in subsection (a), the Secretary shall take af9 firmative steps to assist health care providers subject to 

10 section 1173(c) of the Social Security Act (42 U.S.C. 

11 1320d–2(c)) and section 162.1002 of title 45, Code of 

12 Federal Regulations, in identifying appropriate ICD–10 

13 subcodes. 

Æ 


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