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House bill could delay ICD-10 rollout by one year

House 'doc-fix' bill delays ICD-10 by at least a year


By Joseph Conn
Posted: March 26, 2014 - 2:15 pm ET
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(Story updated at 4:15 p.m. Eastern time.)

The implementation date of the nationwide conversion to the ICD-10 family of diagnostic and procedural codes would be delayed by at least a year under a House Ways and Means Committee bill aimed at providing the annual fix to the physician sustainable-growth rate formula.

The ICD-10 switch is scheduled to occur Oct. 1, 2014. But a single sentence in the proposed legislation says, “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” and finishes by citing sections in the Social Security Act and the Code of Federal Regulations where the secretary's authority to mandate ICD-10 are located.

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The measure was greeted with relief by some who were worried the industry could not be ready for this October and frustration and ire by others upset that those who have invested in meeting this year's deadline may now need to wait another year for others to catch up.

“It's recognition that the industry is simply not ready for the transition,” said Robert Tennant, senior policy adviser for the Medical Group Management Association, which has, along with the American Medical Association, and other professional and industry groups, lobbied HHS for an ICD-10 delay, and for better testing by the CMS of Medicare claims processing for ICD-10 compliance.

“The extension by a minimum of one year—that's' the language, it's not one year—would be a sign to the CMS that they need to be more aggressive with testing and use the year, and not just CMS, to focus on getting end-to-end testing as part of the protocol.”

The delay, Tennant said, also would “really give practices the opportunity to upgrade their software and do internal testing so they'll know exactly what the impact of ICD-10 will mean.”

Tennant said the MGMA and other groups were strongly promoting legislation to do “an overall fix of the SGR,” but as the March 31 deadline loomed before payment cuts under current law would go into effect, “the handwriting was on the wall that a deal may not be possible, so there was some focus on a short-term fixes.” That gave legislators an opportunity to add other proposals, “and one of them was ICD-10,” he said.

“This is a one-year patch for the SGR, something that was worked out between Speaker (John) Boehner and Sen. Majority Leader (Harry) Reid,” said Stanley Nachimson, principal of Nachimson Advisors, a healthcare information technology consultancy specializing in ICD coding. “We should know by this weekend if it happens.”

Both leaders have pledged to allow an up or down vote, Nachimson said, with the House going first on Thursday and the Senate Friday. “This thing, I think, came up rather quickly. It caught a few people by surprise, including me.”

Less than a month ago, CMS Administrator Marilyn Tavenner told an audience of health information technology cognoscenti at the annual Health Information and Management Systems Society convention in Orlando, Fla., that the administration would not delay implementation of ICD-10, adding, “Let's face it guys, we've delayed this several times and it's time to move on.”

For something engineered so quickly, a congressionally mandated switch of the ICD-10 compliance date will have a profound impact on the industry.

In this year's Modern Healthcare annual survey of executive opinions on health IT issues, ICD-10 preparations dominated their plans and preparations, with just 8% of survey respondents indicating their ICD-10 work was done, 57% listed it as a work in progress, 19% said they would start within 12 months, 11% had not started and 5% said they had not considered it. In something of a disconnect between plans and expectations, 36% or survey respondents indicated they were highly confident and 40% were somewhat confident that their organizations would be ready for ICD-10 by the Oct. 1 deadline. Another 12% were unsure, 8% were somewhat pessimistic and 4% were highly pessimistic.

With so much work already underway, Nachimson said, “I would guess that, if this would pass, that would throw a lot of both providers' and ICD-10 implementation plans into question.”

“There will have to be a lot of scrambling around in terms of contingencies,” he said. “Do they need to redo their policies and systems? From the provider standpoint, they will need to make sure they still have the ICD-9 coding capabilities and keep people on board to do that. With any software that they have, they'll have to check with their vendors if they can still use ICD-9.

“If they delay it, we'll live in an ICD-9 world” a while longer, Nachimson said.

Not everyone is happy about the proposed delay. The American Health Information Management Association, long a supporter of an upgrade to ICD-10, is calling on its members to phone their congressional representatives and ask them to have the provision removed from the bill.

AHIMA, in an online newsletter, said “another delay in ICD-10 will cost the industry money and wasted time implementing the new code set. Groups opposing ICD-10 have said that the implementation, with its large increase in codes and need to adapt healthcare systems, causes an unnecessary burden on providers.”

Follow Joseph Conn on Twitter: @MHJConn


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