ICD-10 Delay

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President Obama has signed HR 4302, the Protecting Access to Medicare Act of 2014. After passing in the House on March 27 and clearing the Senate on March 31, the bill was signed by the President on April 1.  This delayed the onset of ICD-10 and patched to the flawed sustainable growth rate (SGR) formula for another year by allowing for a 0.5% increase in payments for the balance of 2014. In addition to preventing the payment cut, PAMA also extends the therapy cap exceptions process for outpatient therapy services.  Providers will continue to use the KX modifier at the $1,920 level and manual medical review at $3,700.

The ICD-10 Delay may prove to be one of the most expensive decisions since the passage of the Affordable Care Act (AKA “Obama Care”). Providers, payers and government agencies have been preparing and spending for the effective date of October 1, 2014. The congressional delay is enough to leave one scratching one’s head: in 2009 congress mandated the original switch in 2013 then later delayed it to 2014. Now it’s 2015. Really? We are already 20 years behind in the switch compared to the rest of the civilized world…CMS was taken off guard by the last minute deal strong-armed by the physician lobby. Congressional leaders clearly did not consult with CMS leadership. But, why would they? CNS doesn’t pay their campaign bills….

This change has literally pushed back the return on investment (ROI) of millions of dollars another year. And, it raises plenty of concerns. “Further delay of ICD-10 discredits the considerable investment made by stakeholders across the country to modernize healthcare delivery,” said CHIME President and CEO Russell P. Branzell, FCHIME, CHCIO. “Providers have already dedicated significant time and resources in financing, training and implementing the necessary changes to workflow and clinical documentation. Any disruption to the ICD-10 transition at this stage would be detrimental.”

It also raises plenty of questions. The PAMA states clearly. “The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD–10 code sets as the standard for code sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d–2(c)) and section 162.1002 of title 45, Code of Federal Regulations.”

But will that mean that ICD-10 codes cannot be used before Oct. 1, 2015? It just means that DHHS cannot declare it a standard. Does that mean healthcare providers and payers might use ICD-10 Oct. 1, 2014? Who knows…CMS is still regrouping from the Congress’s April Fools surprise.

Important decisions will be forthcoming. The events of the last 10 days have born out one immutable truth: the physician lobby in Washington can still be the tail that wags the healthcare dog regardless of the dilatory effects on other healthcare stakeholders.

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