March 31st, 2014
ICD-10, the International Classification of Diseases version 10 from the World Health Organization (WHO) is supposed to go into effect in the United States on October 1, 2014. Today on Twitter, proponents of ICD-10 asked the U.S. Senate not to delay ICD-10 as part of H.R. 4302. H.R. 4301 is designed primarily to re-adjust the Sustainable Growth Rate (SGR) for Medicare payments. Section 212, states that the Department of Health and Human Services (HHS) cannot implement ICD-10 October 1, 2015 or perhaps later.
The final AYE was cast on Monday March 31st at approximately 6:45pm to delay ICD-10 as part of H.R. 4301.
History Repeats Itself
Healthcare.gov, the U.S. Health Insurance Exchange (HIX) went live October 1, 2013 with no real-world testing. Like Healthcare.gov, ICD-10 is going live with much larger financial impact and limited testing by 500 health care providers who submit claims to Medicaid. This testing is currently scheduled for July, 2014 and was only agreed to by CMS after pressure from several sources.
Test ICD-10, Instead of Delaying it Entirely
Unfortunately keeping ICD-10 on schedule or delaying it were probably both bad choices. The reason is that there has been almost no testing of ICD-10 despite its significant impact on the $3 trillion U.S. health care economy. A better strategy would be to keep October 1, 2014 as a deadline and enforce it for testing, much as health care providers must be tested to prove they use electronic health records for Meaningful Use stimulus funds. Exemptions from Meaningful use dates are also provided for. Neither testing or exemptions, even for hardships, are part of the ICD-10 mandate. ICD-10 CM (the U.S. version of ICD-10 diagnosis codes) was not legislated with the same thoroughness of stimulus funds, exemptions and rigorous testing as Meaningful Use of Electronic Health Records. ICD-10 has been delayed before and most physicians didn’t use the extra time to prepare, they just put it off.
Now we’ll have to see if the industry uses the extra time to implement ICD-10 wisely. If this delay is like the last, then history will repeat itself.
ICD-10 Financial Risk Assessment
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February 27th, 2014
Marilyn Tavenner, Administrator of the Centers for Medicare and Medicaid Services spoke at HIMSS 2014 in Orlando Florida about interoperability, and “reduced spending in healthcare,” she said. ”We want to continue to reward programs that provide value and quality. Linking quality data, reporting, and cost of care to outcomes, patient quality for all care settings and tie that to payments.” She also spoke about ICD-10, Meaningful Use Stage 2, Healthcare.gov, interoperability and details about several quality and privacy initiatives.
Ms. Tavenner then commented on important 2014 programs
- Physician Payments Sunshine Act – Payment transparency program requires reporting of any transfer of value between covered drugs, devices, biologicals, and medical supplies and physicians is in the early stages in file exchange, operational in fall 2014. Requires
- ICD-10 deadline – “…no more delays, system going live October 1, 2014.” There will be no change in the deadline. International Classification of Diseases (ICD-10) is required for all HIPAA Covered Entities.
- ICD-10 testing, four prong approachHealthcare.gov – “substantial progress has been made” and we will continue to make improvements to the site to improve usability and reliability for Americans who want to purchase insurance via the federal web site.
- Internal testing
- March beta testing and Medicare testing week
- Tools for providers to test
- July testing – volunteers will be accepted starting in March, totaling 500 total
- Stage 2 Meaningful Use of Electronic Health Records – “we have to have the ability to exchange data among systems and patients so interoperability is key.” Now is not the time to stop moving forward. There will be flexibility in receiving hardship exemptions. ”However we expect providers to comply with Stage 2 MU.” Meaningful Use is specified under Title IV, Division B of the HITECH Act specifying Meaningful Use of Electronic Health Records in 2009.
- Accountable Care Organization (ACO) providers will benefit from data interoperability in these initiatives including uniform transactions.
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