April 9, 2014

Congress Stirred Up ICD-10 Hornet’s Nest

By

Congress has stirred up a hornet’s nest by delaying ICD-10 implementation, and the hornets are those in the healthcare industry who have been diligently preparing for the launch of ICD-10 on October 1.

This includes not only healthcare providers, suppliers, and vendors but also the Centers for Medicare & Medicaid Services (CMS) and professional organizations, such as the American Health Information Management Association (AHIMA) and many others.

 

These “folks are interested in keeping this train moving. They’ve invested lots of money and time,” said Chris Powell, president of Precyse, on the April 8, 2014, Talk Ten Tuesdays broadcast, during which time experts from across the healthcare spectrum shared their insights about the ICD-10 delay.

Others, such as small physician practices and rural hospitals, are not so interested in keeping the train moving. In fact, some of them would like the train to slow down or even stop all together for various reasons, particularly because they cannot meet the financial challenges implementation imposes and they must deal with other Medicare-covered initiatives like Meaningful Use Stage 2.

Many in the industry, such as Margarita Valdez, AHIMA’s director of congressional relations, have lost patience with those who haven’t started to prepare and shared her perspective during the Tuesday broadcast.

“This delay was brought about by a few people who are never going to be prepared,” Valdez said. “The detractors in ICD-10 are those that never had a plan to participate in the implementation process. A small minority has been holding us up,” she added.

For that reason, WEDI plans to hold a summit on April 30, which will be open to the public, to gather input from all aspects of the industry and discuss the current situation and different approaches to implementation.

Playing Politics

In a recent email to ICD10monitor, Nachimson pointed out that the implementation delay was not an action by the Centers for Medicare & Medicaid Services (CMS) but “a political event that occurred,” and Valdez couldn’t agree more.

 “We (AHIMA) spent a lot of time educating members of Congress throughout the year on the benefits of ICD-10 implementation,” she said. “We feel strongly that we had the votes to stop HR 4302 from passage.”  

Many legislators were opposed to this bill, but when the voice vote was taken on HR 4302 “most legislators were not in the room to cast their vote or to object to the vote,” said Valdez.

What Now?

Nonetheless, what’s done is done, so AHIMA, like other associations, is trying to help its members “stay the course and that’s what we need to stress for the industry in general,” Valdez said.

Although several of the other Talk Ten Tuesdays guests also believe that “stay the course” should be the message to send to the industry, Nachimson disagrees.

“I’m a little concerned about the optimism or the recommendation that people simply stay the course and keep doing what they were doing, Nachimson said. “That really wasn’t working.”

Instead, he says, “We should take a deep breath, gather the industry and CMS together—similar to what WEDI plans to do, and sit down and come to a consensus agreement as to how we move forward. The process of everybody going on one day didn’t seem to be the best way to do it plus there was a considered lack of end-to-end testing.”

Holly Louie, member of the Healthcare Billing and Management Association (HBMA), shared her company’s experience with end-to-end testing, which was a very positive experience, she said.

Specifically, her company acted as a beta testing partner with Idaho Medicaid for end-to-end multispecialty physician testing. She explained that Medicaid and its vendor produced a comprehensive work plan, and tests were conducted in real-time. The company submitted parallel ICD-9 coded claims and ICD-10 coded claims.

“There were no issues in parallel coding results,” Louie said. “It went so smoothly, in fact, that we ended testing early because we couldn’t identify any problems, any hiccups or any trouble. I think that demonstrates that it can be done well and efficiently.”

Too bad that cannot be said about ICD-10 implementation.

 

 

Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for RACMonitor.com and ICD10Monitor.com; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.

Related Stories

  • Auditing Issues Uncovered in Physician Documentation: Part III
    Is your Electronic Medical Record (EMR) system helping you pass an audit or hurting you? Editor’s Note: This is the third piece in a four-part series that examines physician documentation issues as seen by an auditor. As we dive even…
  • CMS Issues RADV Blueprint for Handling Flawed Documentation
    New CMS document features gems that fill risk adjustment voids for coding rules. Coders love rules. In risk adjustment coding, we live by the Official Guidelines for Coding and Reporting, the ICD-10-CM conventions for code lookup, and the AHA Coding…
  • CDI: Rejuvenating the Creative Woman
    An inspiring story about rebranding a facility’s CDI department To raise a torch to the strength of women working in healthcare I must share an introductory story on the transformation of a revitalized CDI Department that has pursued success through…