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Updated on: November 21, 2016

Cautious Optimism Prevails as Senate Takes Up “Clean” Medicare Bill

Original story posted on: April 11, 2015

EDITOR’S NOTE – This is the first in a two-part series on industry reaction to the U.S. House of Representatives passage of the H.R. 2 bill.

The U.S. Senate left for spring break two weeks ago, thereby leaving the $214 billion Medicare Bill, H.R. 2, and the Medicare Access and CHIP Reauthorization Act on the table. H.R. 2 contains no language to delay the implementation of ICD-10, which is mandated to be adopted by Oct. 1, 2015.


Though the senators left the Capitol, lobbyists remained in Washington, pushing for amendments that could alter what most had hoped would be a permanent fix to the flawed sustainable growth rate (SGR) formula. Among the possible amendments would be extending the benefits of the Children’s Health Insurance Program (CHIP) from two to four years. Still another contentious issue is one being raised by the American Association of Retired Persons (AARP): they’re concerned that Congress is asking some Medicare beneficiaries to pay more for their medical care.

Meanwhile, now that Congress returned yesterday, the clock is ticking. The Senate needs to vote on the bill as presented by the House on March 26. If there are amendments attached, the bill would go back to the House for another vote, or there could be some intensive negotiations between both chambers. Failure to come to an agreement means the loathsome SGR kicks in, slashing Medicare pay to physicians. Against that backdrop is a house again divided by itself, perhaps most obviously through the tense standoff that’s emerging between Republicans and Democrats over the president’s signature foreign policy initiative of getting Iran to curb its nuclear activities.

The good news for ICD-10 stakeholders in all of this is that efforts to delay ICD-10 were effectively stopped when House Rules Committee Chairman Pete Sessions (R-Texas) on March 25 refused to allow an amendment by Rep. Gary Palmer (R-Ala.) to delay ICD-10 for another two years, until October 2017.

In recognizing that a collective sigh of relief could emerge among healthcare professional associations, Talk-Ten-Tuesdays asked six major professional organizations for their reaction to the pending legislation and also to describe where they are with ICD-10 implementation initiatives. They appeared on the March 31 broadcast – a special 60-minute edition. Here are excerpts from members of four of those associations.


“The passage of a clean SGR reform package out of the House was certainly a relief and an important signal to CHIME (College of Healthcare Information Management Executives) members and the industry,” said Leslie Kringstein, CHIME’s director of congressional affairs. “The passage of H.R. 2 is a testament to the hard work and continued advocacy efforts of a broad coalition of associations and partners. But we must not claim victory quite yet.”

Kringstein, a guest on the March 31 edition of Talk-Ten-Tuesdays, told audience members that many CHIME members have reported that the "stop and start" environment created by prior implementation delays has been disruptive and costly, and must not reemerge.

“The biggest hurdle our members cite is not technology, it’s the uncertainty surrounding the implementation date,” Kringstein said during the broadcast. “The stop-start mentality associated with ICD-10 implementation over the past few years has been extremely detrimental; however, we see the passage of the SGR fix in the House as a signal that the industry can and must plan to move full speed ahead.”

Kringstein told audience members that the SGR reform package’s focus on value and quality over service volume would only benefit from a robust code set.

“ICD-10 implementation is coming at a critical time, as new care models are instituted requiring greater coding accuracy and specificity,” Kringstein said. “The nation will see these benefits in national healthcare initiatives, including the meaningful use program, value-based purchasing, ACOs, and quality reporting.”


“Passage of the ‘doc fix’ bill without inclusion of ICD-10 delay language is a significant accomplishment, but we are not entirely out of the woods yet,” Sue Bowman told Talk Ten Tuesdays listeners during the broadcast. Bowman, senior director of coding policy and compliance for the American Health Information Management Association (AHIMA), warned that there were still opportunities for ICD-10 delay language to be introduced in legislation between now and Oct. 1, the date by which compliance has been mandated.

“We (AHIMA and our ICD-10 coalition partners) will continue to keep a watchful eye out and will continue to meet with members of Congress to ensure they understand why we need to transition to ICD-10, how delays have been costly and disruptive, and why another delay is not a solution,” Bowman said.

Understandably, some stakeholders remain skeptical that there won’t be another delay, having experienced an unexpected setback last March when the 17th “doc fix” patch that Congress had applied to the SGR delayed ICD-10 to Oct. 1 of this year.  

“While there is always the possibility that something could still happen to delay ICD-10, there is every indication right now that ICD-10 will be implemented on Oct. 1,” Bowman said. “Providers should not expect ICD-10 to be delayed again and should move full steam ahead with transition preparations in order to ensure they are ready for the compliance date.” 


“HBMA (the Healthcare Billing and Management Association) has been focused on helping our members and their clients prepare for ICD-10 since 2009,” Holly Louie, HBMA’s president-elect, told audience members. “We’ve brought a broad perspective to this process and in the variety of individual members and organizations represented on our ICD-10 committee.” 

Explaining to the audience that her association’s members are revenue cycle professionals, she said the association has been tackling what she described as the “big picture” and not just the code set changes.

“In addition to coding, we know our payors, our vendors, our clearinghouses, and our clients,” Louie explained. “We well know the problem areas and risk areas now, but more importantly, we know those issues likely to come. We are further refining those as we gain end-to-end testing experiences. End-to-end testing is finally starting to roll out, and that is just an absolute necessity for readiness.”

The delay in implementing ICD-10 has had a ripple effect throughout the industry, especially among software vendors, with stakeholders pointing accusatory fingers at one another.

“We are well aware that some of the industry key players have delayed investments and preparation in case, maybe in hopes of, another delay,” Louie said. Quoting from Alice in Wonderland, Louie said the only message that comes to mind is “I’m late, I’m late, for a very important date.”

“Fast and furious” is how Louie described activities to be performed during the remaining time to complete implementation of ICD-10. Louie said that in many cases, a year’s preparation must now be done in the remaining six months. Louie described two essential initiatives the association is instructing its members to take:

“You must have (a handle on) financial needs, operational impact, viable contingency plans and resources, and tools to help clients succeed,” Louie said. “(You should help) put the finishing touches on those more advanced programs, for example, what changes may be required based on end-to-end testing experience.”

Louie said that testing will uncover problems that need to be corrected, noting that she heard during the broadcast that one payer returned Adobe files for the 835 response.

“How could anyone, including a payor, possibly manage that?” Louie asked the audience.

Louie said the data the association is gathering would allow strategic positioning for its clients. 

“We are closely monitoring our members’ experiences with payers and testing so we can anticipate where claims disruptions will most likely occur, Louie explained. “Forewarned is forearmed.”

Cooperative Exchange

“We are committed to promoting and advancing electronic data exchange for the healthcare industry by improving efficiency, advocacy, and education to industry stakeholders and government entities,” said Betty Gomez, representing the Cooperative Exchange, an association that represents clearinghouses. “Our members are committed to helping providers and payers with the ICD-10 implementation.”

“One of the areas the industry has been concerned about is the lack of knowledge on what to expect from payers regarding ICD-10 testing,” Gomez told audience members, noting that clearinghouses’ testing results have indicated that providers frequently are testing to test the payer and have forgotten that they need to get their own shop ready. 

Gomez described an online resource the association developed to gather information on payors regarding ICD-10 testing readiness and parameters for testing: the ICD-10 Payor Testing Directory.

“It is a public one-stop resource on the CE’s (Cooperative Exchange) website,” Gomez explained. “This is a value add for both clearinghouses and providers.”

The site will feature a directory with each payer’s name, line of business, testing type, and date along with URLs, contact information, testing requirements, and other testing information.

The online tool, http://www.cooperativeexchange.org, is expected to be available this week (April 20).

“We have had a hard time getting providers to give us the full claim counts they were allotted,” Gomez explained. “Organizations just want ‘to make sure the payer can process and reimburse the claim correctly,’ but also that they really need ‘to make sure their processes, from doctors notes to coding to their HIS system, are ready and can produce ICD-10 claims at the same efficiency and speed as they currently do ICD-9 claims.’”

Gomez said that since several clearinghouses have signaled that they expect to finish testing in July and then will focus on transition activities, providers should be ready to begin testing as well.

“Providers need to make sure their systems are ready so they can engage in testing before the end of July,” Gomez said.

“Providers should make sure they have the ability to produce an ICD-10 (claim) at the same speed and efficiency the ICD-9 is currently produced. This I would define as readiness.”

Next Tuesday: The second part of this series will feature reactions from the American Association of Professional Coders (AAPC), the American Hospital Association (AHA), the Workgroup for Electronic Data Interchange (WEDI), as well as Chris Powell, Precyse’s CEO, and Stanley Nachimson.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Chuck Buck

Chuck Buck is the publisher of ICD10monitor and is the executive producer and program host of Talk Ten Tuesdays.

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