A delay should not stop your momentum

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Marilyn Rissmiller, Senior Director, Health Care Financing

The bill that stopped a scheduled 24 percent Medicare pay cut to physicians also delayed the transition to the ICD-10 code set for at least an additional year. The U.S. House of Representatives passed H.R. 4302, the “Protecting Access to Medicare Act of 2014,” on March 27. The Senate passed an identical version of the bill on March 31 and President Obama signed the legislation into law on April 1.

Experts speculate that including the ICD-10 delay in the bill was likely done to appease physicians who opposed another temporary SGR patch. Congress was unable to find a way to pay for a permanent repeal of the SGR, a cost of $140 billion over 10 years. But the ICD-10 delay won’t be cheap either; the Centers for Medicare and Medicaid Services estimates that this delay could cost between $1 billion and $6.6 billion, as referenced in a statement from the American Health Information Management Association (AHIMA).

“This is approximately 10-30 percent of what has already been invested by providers, payers, vendors and academic programs,” AHIMA said in the statement. “Without ICD-10, the return on investment in EHRs and health data exchange will be greatly diminished.”
Physician practices have been working for the past two years to transition from ICD-9 to ICD-10, which adds more than 50,000 codes for diseases and procedures to allow for greater specificity in billing and mortality and morbidity data. The U.S. Department of Health and Human Services already delayed the ICD-10 compliance date once, in August 2012, from Oct. 1, 2013, to Oct. 1, 2014.

The current delay measure states, “The Secretary of Health and Human Service may not, prior to Oct. 1, 2015, adopt ICD-10 code sets as the standard for codes sets.” AHIMA CEO Lynne Thomas Gordan called the delay “unfortunate” and has said they will seek clarification on the exact length of the delay “on behalf of our more than 72,000 members who have prepared for ICD-10 in good faith.”

Russell Branzell, president and CEO of the College of Healthcare Information Management Executives (CHIME), also criticized the delay in a statement. “We are extremely disappointed by today’s vote. We understand the considerable hours, resources, and money CHIME members and their organizations have spent preparing for the transition. This pause in momentum discredits the significant work our industry has spent training staff, conducting testing and converting systems; not to mention the hold on improving care quality and accuracy, advancing clinical reporting and research, and patient safety outcomes.” 

“CMS must now provide new guidance to the industry on what the delay means for providers, vendors, clearinghouses and other concerned parties. The delay leaves numerous unanswered questions from testing, training and revamping the agency’s education resources.”

Experts speculate that the federal CMS could allow organizations ready to implement ICD-10 to implement the code set voluntarily. Or they could forego ICD-10 altogether and instead wait for ICD-11, which is due to be released in 2017 and will be used throughout much of the rest of the world.

The Colorado ICD-10 Training Coalition encourages practices not to lose momentum. Those ready for implementation can access archived webinars on the coalition website, www.cms.org/icd-10, to refresh and improve your skills, and those who need another year can increase your readiness through proactive education, practice and testing. Use this postponement to increase your knowledge, review and adjust documentation quality and clinician education, and adjust coding and billing procedures – without the weight of the 2014 deadline. The coalition will continue to hold webinars and post resources on our website and we’ll provide more information on the delay as it is available.


Categories: Communications, Colorado Medicine, Practice Management, Coding and Billing