Possible ICD-10 Implementation Delay

 Possible ICD-10 Implementation Delay

Recently, there has been a stir amongst the medical community regarding the implementation of ICD-10.

This is not the first time ICD-10 has caused a stir. The United States Department of Health and Human Services (HHS) has already pushed back ICD-10 implementation once before, and H.R. bill 1701 (Cutting Costly Codes Act of 2013) is still up for vote as it was passed onto the House Subcommittee on Health and the Senate Committee on Health, Education, Labor and Pensions in April and May of 2013, respectively. According to the American Academy of Family Physicians, Dr. Jeff Cain wrote to Secretary Kathleen Sebelius in February requesting that she reconsider the deadline for implementation of ICD-10.

Cain’s concerns were as follows:

• Lack of appropriate education - As of February 2014, 79% of providers are not ready or haven’t begun implementation yet according to MGMA
• Expense to implement (costs between $56,639 and $226,105 according to AMA)
• Lack of adequate end-to-end testing
• Multiple health plans and payers is causing more expense and challenge across the country
• CMS has only focused on testing and training within hospitals and large health system, not small or medium sized practices
• Implementation will interrupt cash flow, putting small and medium sized practices out of business
• This includes rural and underserved patients

Suggestions made by Cain to Sebelius include:

• Increasing CMS funding to create more educational resources for smaller practices
• CMS should require end-to-end readiness testing each month for one week until July 2014
• Results should be made public and show effectiveness of the system
• If results are not positive, delay ICD-10 implementation for at least one more year
• Provide funds to Medicare contractors for education on the use of ICD-10 codes

Although CMS Administrator Marilyn Tavenner, M.A., has already confirmed the deadline will remain intact, legislation to patch the sustainable growth rate (SGR) for another year could potentially delay ICD-10 implementation until October 1, 2015. Currently, the 121-page bill has been crafted for vote March 27, 2014 (today) by Congress, which would also extend the current SGR fix until March 31, 2015. This extension could prevent reduced Medicare payments (24%) to providers in addition to delaying the ICD-10 implementation.

Wherever you are in learning about ICD-10, you should know that it is imperative to keep on chugging along and never count on further delays. It’s always best to be prepared for anything when it comes to your patients care and for your own sake, your own revenue! CMS has released a document containing resources to aid those having trouble with ICD-10 implementation. 


As an update --- As of April 1, 2014 --- The Senate passed the bill delaying the implementation of ICD-10 for one year until 2015! 

Sources:

http://www.aafp.org/news/practice-professional-issues/20140227icd10delayltr.html

http://cms.gov/Medicare/Coding/ICD10/Downloads/ICD10-ResourcesFlyer20130913remediated.pdf

http://medicaleconomics.modernmedicine.com/medical-economics/news/proposed-sgr-patch-includes-one-year-icd-10-delay
http://www.ihealthbeat.org/articles/2014/3/28/reaction-to-icd10-delay-mixed-ahead-of-senate-vote-on-doc-fix 
http://www.hitconsultant.net/2014/03/31/icd-10-delayed-to-2015-senate-passes-sgr-doc-fix/

Reimbursement for Your Performance

Reimbursement for Your Performance 

In the past, PAs have not been given much attention to reimbursement, specifically the requirements of of coding, documentation, and the rules of reimbursement affecting whether YOU are going to get reimbursed for your services as a PA. This is IMPORTANT!

How Is Our Healthcare Reimbursement System Structured?

Medicare sets the standard policy - the rules of the game which everyone should follow. There are then 14 Medicare Administrative Contractors (MACs), which basically function as individual branches that enforce policy around the country, by state or region. This system is sort of like how our government works, with a few differences. The rules come from the capital in D.C. and then each state is responsible for enforcing the rules, but here, the MACs are responsible for enforcing the rules in a way they interpret them. Medicare HMO (health maintenance organization) products are written by private carriers - they basically follow the rules of Medicare with a few changes to the policy as they see fit. Private insurance companies like Blue Cross/Blue Shield, UnitedHealthcare, Cigna, Aetna, and Humana, provide policies with various combinations of benefits, and are not required to follow Medicare policies, which is the practice of "free enterprise" we have in the US. This also means they're not required to follow the coding practices for the Current Procedural Terminology (CPT) or the International Classification of Diseases, 9th Clinical Modification Edition (also known as ICD-9). If you know anything about healthcare, these codes are used to say, "okay, this procedure is for excision of the sigmoid colon due to diverticulitis." There is a corresponding CPT and ICD-9 code that represents medical, surgical, and diagnostic services to communicate with everyone - clinical, financial, administrative, etc.

What's the big deal?

The problem is that PAs can encounter different codes from different carriers, especially private carriers who do not have to use the same coding systems as everyone else. That's what makes reimbursement a "moving target." In addition, on OCTOBER 1, 2014, the entire US will make the largest change diagnostic coding will see in our careers. We will switch over from ICD-9 to ICD-10. This can only mean better healthcare outcomes for our patients. For example, with ICD-10, more diagnoses are going to be implemented into the current system of codes, but also, more descriptive diagnoses. This means that when you go to choose a code matching your diagnosis, it should be less likely to be shot back from the carrier reimbursing your services. In addition, also means that YOU as a PA need to learn the required documentation requirements and stay up-to-date on your responsibilities, especially changes in policy in your area. Your salary, bonuses, and eventually, the ability to provide valuable, quality healthcare to your patients could be affected. This could be huge for the practice of medicine, and not for just PAs!