Updated on: March 17, 2016

ICD-10 Delay: Politics Versus Policy

Original story posted on: March 31, 2014

Politics and policy intersected yesterday when the U.S. Senate took up the House proposal from last week and voted to approve H.R. 4302, the Protecting Access to Medicare Act of 2014. Language in the bill, tucked among other provisions, effectively delays the implementation of ICD-10 by one year.


“This surprise delay was not an action by the Centers for Medicare & Medicaid Services (CMS) but a political event that occurred,” wrote Stanley Nachimson in an email to ICD10monitor. “It (the delay) will, however, cause much chaos in the industry as health plans scramble to adjust their systems and policies back to ICD-9 from their planned October 2014 ICD-10 implementation.”

Not only will providers be affected by the delay, Nachimson said, but vendors will too.

“Vendors will also have to adjust their products to account for the date changes,” he wrote. “Providers will have to determine how to change their implementation projects.”

Nachimson hinted at what could be defined as an institutionalized skepticism when he questioned whether the delay instituted by yesterday’s vote might foretell additional future delays.

“Of greater concern is the bigger question – will this be the last delay of ICD-10, or will there be further political or technological surprises?” Nachimson asked. “Some will assume that the switch to ICD-10 will never happen and drop all efforts; others may be very wary of continuing to expend significant resources on the project.”

Nachimson and others will be keeping a keen eye on what transpires in the months ahead, and how providers and payors react to new statements from CMS.

“Messages from CMS and the industry will be important to monitor over these next few months to see what the prevailing attitude will be,” he said.

Although yesterday’s vote was disappointing for the American Health Information Management Association (AHIMA), the association was quick to affirm its commitment to those who are continuing with the transition from ICD-9 to ICD-10.

AHIMA will continue to help lend technical assistance and training to stakeholders as they are forced to navigate the challenge of continuing to prepare for ICD-10 while still using ICD-9,” the association stated in a news release.

In the meantime, the question remains as to what providers should be doing during an uncertain interim — both those that continue to remain on schedule and those that would not have completed their implementation efforts by the mandatory date of Oct. 1, 2014.

“For those facilities and providers that have been proactive with preparations for ICD-10 and have diligently been training, testing, and coordinating efforts with payors – keep doing what you have been doing,” wrote Lisa R. Winther, senior healthcare consultant for Hayes Management Consulting, in an email to ICD10monitor. “(Providers) should (continue) to perform dual coding (while) training your staff and testing your systems.”

Winther advised providers to take advantage of this extra time to ensure ICD-10 proficiency with staff by continuing to dual-code. She also offered other suggestions for using the additional time.

“This gives you more time for your compliance and audit areas to provide valuable feedback to the providers for proper documentation, and also to your coders for accuracy and productivity,” Winther said. “It (the delay) also allows more time to perform enterprise testing to ensure (that) all systems are ready for the increased data field sizes for the ICD-10 codes, interfaces are working correctly, and all hubs in between can accept and move forward (with) the correct information.”

Winther reasoned that the delay ultimately would have a beneficial consequence on ICD-10 implementation.

“This is a perfect time to address all of these items, along with the many other ‘small things’ that we overlook,” she wrote. “Make a checklist of all of these items to ensure they are completed, tested, and ready for the implementation date – oh, and don’t forget the workflow changes that may need to take place to accommodate some of these updates.”

The provision for extending the delay was tucked into the House bill to extend the Sustainable Growth Rate (SGR) formula for another 12 months rather than finding a permanent solution to the 1997 Balanced Budget Act, which attempted to rein in Medicare reimbursement to physicians. The “doc fix” to temporarily repeal the SGR averts a scheduled 24-percent reduction to physician reimbursement that would have kicked in April 1.


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.