July 31, 2014

ICD-10 Final Rule Stirs Angst, Apprehension

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On a late Thursday afternoon, with the last minutes ticking down on Major League Baseball’s non-waiver trade deadline, the U.S. Department of Health and Human Services (HHS) posted a final rule regarding ICD-10 implementation in the Federal Register. While the outcome of today’s trades might end speculation regarding how the remainder of the current MLB season will pan out, the HHS announcement did little to remove doubts that a “done deal” is in place, to borrow from common parlance.

 

“The publication of the rule provides some assurance to the industry that CMS (the Centers for Medicare & Medicare Services) will be supporting the Oct. 1, 2015 (implementation) date, and that Medicare and Medicaid will be aiming towards that date,” industry expert Stanley Nachimson said in an email to ICD10monitor. “It also removes the excuse that some have used about not having any ICD-10 compliance date (codified) in regulation. The industry can now focus its efforts on meeting the new date, hopefully with a renewed commitment and an improved approach.”

Yet Nachimson was quick to seize on a point that has been made by others about the circuitous path to adoption.

“We must recognize that even with this final rule, there is still the possibility that if the industry does not make significant strides towards readiness, the date could be moved again – maybe by Congress, or maybe even by (CMS).”

Challenges Facing Physician Practices

All along, the American Medical Association (AMA) opposition to ICD-10 adoption has been consistent and unrelenting, with association leaders calling ICD-10 an unfunded mandate.

In the nation’s capital, the Medical Management Group Association (MGMA) has voiced similar concerns, citing conversion problems likely to be faced by physician practices.

“CMS has now published the date for when physician practices and other must move to ICD-10,” MGMA Senior Policy Advisor Robert Tennant wrote in an email to ICD10monitor. “This conversion has proven so far to be extremely difficult for practices and their trading partners to accomplish.”

Tennant also raised concerns about a federal regulatory environment that appears to be placing more demands on physician practices. And Tennant also questioned the CMS stance on end-to-end testing — long a point of contention among ICD-10 stakeholders. Chief among the MGMA’s concerns is anticipated cash flow disruption should ICD-10 be adopted by Oct. 1, 2015, as now mandated in the new final rule.

“Despite the additional time, facing multiple federal quality reporting requirements and an uncertain payment environment, practices may continue to experience challenges with software upgrades, workflow modification and staff training,” Tennant said. “Absent Medicare and other public and private health plans aggressively pursuing end-to-end testing and being fully transparent in terms of payment policies well in advance of the compliance date, we remain concerned that cash flow following Oct. 1, 2015 could be disrupted.”

Interim Versus Final Rule

Tim McMullen, executive director of the Cooperative Exchange, an association of clearinghouses, was quick to point out that the final rule requires the continued use of ICD-9 through Sept. 30, 2015 – while noting that as such, the rule will forbid any health plan from starting to use (or requiring others to use) ICD-10 beforehand. 

“We are concerned that HHS chose to make this a final rule rather than an interim final rule, which then precludes an opportunity for an industry comment period,” McMullen said in an email to ICD10monitor. 

Time and Time Again

A common, recurring rationalization among industry leaders was that the delay would give stakeholders more time to prepare for the transition to ICD-10, particularly in the area of end-to-end testing.

Holly Louie, who heads up the ICD-10 Committee of the Healthcare Billing and Management Association (HBMA), expressed a sense of urgency about end-to-end testing.

“The immediate needs (center on) end-to-end testing with all major payers and wide stakeholder participation,” Louie wrote in an email to ICD10monitor. “We are focused on assisting all of our members to not only prepare, but to work closely with their physicians and clients.” 

How Do You Spell Relief?

To the point that many have made regarding the fact that a definitive date for ICD-10 compliance now has been established, some say that stakeholders can move forward with their implementation plans with confidence.

Long a champion of ICD-10, the American Health Information Management Association (AHIMA) told ICD10monitor in a written statement that the association “applauds the confirmation by the Centers for Medicare & Medicaid Services (CMS) of Oct. 1, 2015 as the compliance date for ICD-10-CM/PCS. Now, everyone in the healthcare community has the necessary certainty to move forward with their implementation processes, including testing and training.”

AAPC, boasting arguably the largest membership of professional coders, found relief in the news regarding the final rule. For months, there has been growing industry speculation as to when the federal Office of Management and Budget (OMB) would issue the final rule for publication in the Federal Register.

“We are so glad to see the date finally published. We believe that this will help move the industry forward,” wrote Rhonda Buckholtz, vice president of ICD-10 education and training for AAPC. “We are hopeful that with the release of the compliance date that the industry will continue to move forward and allow the appropriate times for testing and increasing productivity.”

In the meantime, MGMA signaled a desire to assist its members with the transition — if and when the final rule survives any potential landmines — and to debate on the divisive Sustainable Growth Rate (SGR). Nearly five months after the night of April 1, when the U.S. Senate voted to approve a measure that prevented draconian cuts to physician payments that would have occurred under the SGR formula, that prospect looms ahead.      

“We will continue efforts to educate our members on this complex change and prepare them for this transition,” Tennant said. 

Beyond ICD-10

Precyse CEO Chris Powell took the long view on the final rule announcement. Looking beyond ICD-10, Powell told ICD10monitor that the successful transition to ICD-10 would lead to other benefits.

“Staff education, clinical documentation improvement processes and process improvement efforts that support a successful transition to ICD-10,” said Powell,” will also give providers a stronger foundation for other strategic initiatives embarked upon under the Affordable Care Act."

 

References

ICD-10 Final Rule

CMS News Release

Chuck Buck

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