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Medical Provider Readiness for ICD-10?

11 Responses

1. Hope R. Hetico RN MHA, on February 20, 2014 at 6:05 PM said:

   ICD-10 Conversion Progress
   [Percent of Conversion Completed by Healthcare Providers]

   Conversion Progress 2013 2014

   Haven’t Started…………..33.8% 15.3%
   25% ……………………… 40.8% 35.4%
   50% ……………………….18.8% 31.1%
   75% ……………………….05.8% 17.1%
   90+% ………………………80.0% 01.2%

   50.62% Healthcare Providers Are Still Only 25% or Less Completed in Their ICD-10 Conversion Process‏

   Source: Aloft Group

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2. Claude, on March 27, 2014 at 12:12 AM said:

   Temporary ‘Doc-Fix’ and ICD-10 Agreement Reached?

   Another temporary 12-month patch will be enacted for the “doc fix” prior to the scheduled March 31st expiration of the current patch, House Speaker John Boehner (R-OH) indicated Wednesday.

   The House bill authorizing the latest patch also includes provisions to extend the deadline for ICD-10 implementation to at least October 2015, and a provision which would give hospitals until March 2015 to comply with a controversial new inpatient payment rule for hospitals known as the “two midnight rule”.

   Whether the full House and Senate will go along with all the additional provisions added on to the doc fix remains an open question, but a vote on the House bill is likely soon with a Senate vote, assuming House approval.

   Source: Paul Demko, Modern Healthcare [3/26/14]

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3. Hope R. Hetico RN MHA, on May 6, 2014 at 7:44 PM said:

   New ICD-10 Transition Date Set for 2015

   The Centers for Medicare and Medicaid Services (CMS) announced yesterday that it would require the use of the International Classification of Diseases, 10th Revision (ICD-10), set of diagnostic codes starting October 1, 2015. That is one year later than the ICD-10 transition date that was in effect until recently.

   The CMS announcement, eagerly anticipated in the healthcare industry, was a response to Congress’ passage in late March of a bill that prohibited the agency from setting a deadline for ICD-10 any earlier than October 1, 2015. That provision was part of legislation that also prevented a 24% reduction in physicians’ Medicare payments.

   Source: Ken Terry, Medscape Medical News [5/2/14]

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4. Ann Miller RN MHA, on December 6, 2014 at 6:55 PM said:

   Physicians, IT leaders Mull ICD-10 Compromise but Brace for Fight

   Many, but not all, physicians oppose the federal push to implement ICD-10. One doc who wants an ICD-10 deflection rather than a full stop is Dr. Joseph Schneider, chief medical information officer and medical director of clinical information at Baylor Health Care System, Dallas. “We’ve got to find some middle ground on this,” he pleaded. But Schneider’s moderate stance on ICD-10 puts him at odds with his own state medical society, which recently turned up the gas on an already simmering ICD-10 cauldron. The association—of which Schneider is a member—posted a call to action on its website, urging its 48,000 members to join with physicians nationwide in writing to Congress, asking it to delay ICD-10 implementation for two years.

   Meanwhile, the Association of Medical Directors of Information Systems, a professional association of physician informaticists, recently posted Schneider’s compromise proposal on the AMDIS listserv, where it garnered both support and criticism. The plan calls for going forward with the current Oct. 1, 2015 compliance date, but making ICD-10 use optional for hospitals and physicians for the next three years. Health plans and other claims handlers, however, would be required to process claims in either the currently used ICD-9 code sets, if that’s how they’re received, or in ICD-10. A multidisciplinary panel—he likened it to the 1990s’ military base-closing commission—would lead a national discussion on clinical coding and come up with a transition plan.

   Source: Joseph Conn, Modern Healthcare [12/5/14]

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5. Ann Miller RN MHA, on December 10, 2014 at 2:55 AM said:

   ICD-10 Delay Appears DOA in Congress This Year

   A proposal to delay implementation of ICD-10 diagnostic and procedure codes by an additional two years appears to be going nowhere in the current lame duck session of Congress. “That’s not going to happen,” said a veteran healthcare consultant who tracks the issue closely, speaking on background. “The reports of them ever getting traction were overrated.” The Texas Medical Association has been lobbying for the two-year delay. The nation’s largest state medical society for physicians, with 48,000 members, wants to push back the adoption date for the oft-delayed change to 2017.

   The federal government is set to run out of money Dec. 11 if Congress doesn’t authorize additional spending, making a funding bill a perfect vehicle for attaching special causes such as an ICD-10 delay since the overall bill must pass to keep the government open. But the proposed ICD-10 delay, which would infuriate other interested healthcare parties that have been moving forward with plans to implement the coding changes next year, doesn’t appear to be going anywhere.

   Source: Joseph Conn and Paul Demko, Modern Healthcare [12/8/14]

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6. Sam, on December 23, 2014 at 1:07 AM said:

   75 percent of doctors holding off on ICD-10

   An overwhelming majority is waiting until next year to undertake the code set conversion and, what’s more, nearly half of them expect that it will cost less than $10,000.

   http://www.medicalpracticeinsider.com/news/75-percent-doctors-holding-icd-10?email=%%EmailAddress%%&GroupID=90115&mkt_tok=3RkMMJWWfF9wsRokvqrMZKXonjHpfsX56O0kXK6zlMI%2F0ER3fOvrPUfGjI4CTMZhI%2BSLDwEYGJlv6SgFQ7LHMbpszbgPUhM%3D

   Sam

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7. Ann Miller RN MHA, on May 9, 2015 at 11:19 AM said:

   Re-introduced U.S. House Bill Would Stop ICD-10

   Rep. Ted Poe (R-TX), supported by six of his Republican colleagues, has introduced a House bill to block the government-mandated transition to the International Classification of Diseases (ICD)-10 diagnostic code set in October. Dubbed the Cutting Costly Codes Act of 2015, the legislation would prohibit the Secretary of Health and Human Services from requiring the medical community to comply with the ICD-10 codes.

   Instead, the bill would have the US Government Accountability Office conduct a study “in consultation with stakeholders in the medical community…to identify steps that can be taken to mitigate the disruption on healthcare providers resulting from a replacement of ICD-9 as such a standard.”

   Source: Ken Terry, Medscape News [5/7/15]

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8. Ann Miller RN MHA, on June 10, 2015 at 10:28 PM said:

   House Bill Seeks ICD-10 Grace Period
   

   With the October 1st. ICD-10 deadline rapidly approaching, another member of Congress has introduced legislation that would establish a “grace period” following the compliance date during which providers could not be denied Medicare/Medicaid payments because of coding errors.

   Rep. Gary Palmer (R-AL) has sponsored the “Protecting Patients and Physicians Against Coding Act” (H.R. 2652) which calls for a two-year grace period so that providers can “focus on patient care instead of coding and receiving compensation for their care while ICD-10 is being fully implemented.”

   With ICD-10’s five-fold increase in codes compared to ICD-9, Palmer warned that the code switchover creates significant administrative challenges for rural and small town providers in particular, who lack the resources to fully prepare for the ICD-10 implementation.

   Source: Greg Slabodkin, Health Data Management [6/10/15]

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9. Dreama Sloan-Kelly MD, on July 9, 2015 at 3:22 PM said:

   ICD-10 transition

   Upon returning from my July 4th holiday I was greeted with a hot off the press email from the American Medical Association (AMA) announcing a partnership with CMS “to make the ICD-10 transition less disruptive for physicians”.

   First I must state, after reading the statement from the AMA, and CMS, along with some of the internal letters I have received from legislators in Washington, D.C., I can pretty much guarantee you that there will be no further delays and ICD-10 will become effective October 1, 2015.

   Along with this, I also feel comfortable in stating there will be no grace period either. However, according to the AMA, CMS has made some changes to help ease us into the transition to ICD-10 and ensure that we get paid — because at the end of the day that is the main issue we are concerned about, along with compliance. CMS’s notice states: In accordance with the coming transition, the Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of services after September 30, 2015, nor will they be able to accept claims for both ICD-9 and ICD-10 codes. So with that said, what are they going to do to help physicians, their practices, and hospitals, to make this transition as painless as possible?

   Based on physician’s fears of the transition to ICD-10 the AMA lobbied CMS to enact some changes to the ICD-10 implementation policy to take some of the burden off physician practices and hospitals. AMA released a joint statement with CMS Monday stating that CMS has agreed to the following changes:

   1. No claim denials based on the lack of specificity of the ICD-10 diagnosis code chosen for ONE year. According to the AMA, CMS has agreed to the following: For the first year ICD-10 is in place, Medicare claims will not be denied solely based on the specificity of the diagnosis codes as long as they are from the appropriate code family of ICD-10 codes. Sounds great on the surface but I have a few concerns with this statement. I come from the school of thought that since this is only lasts for one year this can be a set up for denials and compliance issues down the road. Teach providers how to document and code correctly from the start. It is much easier to train someone to do things correctly from the beginning rather than training them out of bad habits. I do not want to see groups a year from the transition, October 1, 2016, facing denials due to lack of specificity of the ICD-10 code.

   2. No penalties based on PQRS. According to the AMA release: CMS will not subject physicians to penalties for the Physician Quality Report Systems (PQRS) based on the specificity of diagnosis codes as long as they use a code from the correct ICD-10 family of codes. Again I state, why not train staff correctly from the beginning. Along with this, there was no time frame stated — the one year could be implied but I never imply anything when it comes to federal agencies.

   3. AMA stated that CMS assures providers that if a Medicare contractor is unable to process claims due to problems with ICD-10, “CMS will authorize advance payments to physicians”. Seeing that Medicare carriers should have made the transition in regards to their software systems already I am thinking this will not become an issue however it is reassuring to know that CMS has a plan in place in case there are problems.

   4. CMS plans to create an ICD-10 Ombudsman. According to the AMA, CMS plans to “establish a communication center to monitor issues and resolve them as quickly as possible”. The ombudsman will be “devoted to triaging physicians issues”. Who this ombudsman will be is left to be seen however I hope it is someone with dual experience — a physician and coder.

   After reading through the changes it should be clear that CMS is dedicated to helping providers ease into the transition but are also taking a hard stance in regards to the implementation date of October 1, 2015.

   As I have mentioned above, it is my professional opinion that you use this time to fine tune physician clinical documentation and coding, and use it as an opportunity to uncover any glitches in your current system after the implementation date. Take this time to continue training and auditing and do not encourage providers to choose unspecified codes. If there is not enough clinical documentation provided to support the most specific ICD-10 code but supports the unspecified code in the ICD-10 code family, then of course bill that code after the implementation to ensure there are no breaks in cash flow.

   However, use that office visit note as a teaching moment — noting for the provider what clinical documentation needs to be documented to support the most specific codes and what codes need to be chosen. The one year mark will be here before we know it and trying to train providers out of bad habits will not work. Even though the AMA states that “medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes”, it does not mean there will NOT be audits. I have been in enough audits to know that this statement can be a catch 22.

   Do it right from the start.

   Dreama Sloan-Kelly MD CCS

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10. Ann Miller RN MHA, on July 12, 2015 at 8:20 AM said:

    New ICD-10 bill in House Would Permit Dual Coding for 180 Days

    Legislation proposed in the House would permit providers to code in either ICD-9 or ICD-10 for half a year after the ICD-10 implementation deadline, now set for Oct. 1.

    The bill, Coding Flexibility in Healthcare Act of 2015 introduced by Rep. Marsha Blackburn (R-TN) and co-sponsored by fellow Republican Rep. Tom Price (R-GA), a physician, would also require HHS to report to Congress 90 days after implementation of ICD-10 on the impacts the new codes are having on providers, patients, and other stakeholders.

    The bill has already garnered support from the Medical Group Management Association, a professional association for physician group practice leaders and managers.

    In a letter to Blackburn and Price, Dr. Halee Fischer-Wright, MGMA president and CEO, said the bill would afford physicians “much needed flexibility and provide a window of time to address inevitable system issues to ensure claims are processed and paid.”

    Source: Joseph Conn, Modern Healthcare [7/10/15]

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11. Ann Miller RN MHA, on September 16, 2015 at 11:52 AM said:

    ICD-10 Conversion Could Drive Some Small Doctor Groups Out of Business

    Ready or not, the U.S. healthcare industry is poised to flip the switch from the ICD-9 to the ICD-10 diagnostic and procedural coding system on Oct. 1, significantly changing how billions of dollars in medical claims are calculated and billed every day.

    In fact, experts predict most large hospitals and health systems and most large physician groups will weather the federally required conversion just fine, though they could experience temporary cash-flow squeezes because of ICD-10-related payment delays.

    The organizations most likely to have trouble, however, are smaller providers, particularly smaller physician practices. Some medical groups say problems associated with the conversion could drive some small doctor groups out of business. A last-minute reprieve is unlikely. After three previous delays of the ICD-10 start date, no one predicts there will be a fourth.

    Source: Joseph Conn, Modern Healthcare [9/12/15]

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