One of the most sophisticated reimbursement models in the United States involves hierarchical logic for grouping a coded health record into a designated payment group based upon the Medicare Severity Diagnosis Related Group (MS-DRG). This is the basis of payment used in the Medicare Inpatient Prospective Payment System (IPPS). The…
As an integrated healthcare system, Kaiser Permanente is in a unique position when it comes to testing ICD-10. In order to become ICD-10-compliant, the company must test from the position of both a provider (caregiver) and a payer (insurance plan). During the coming months, Kaiser Permanente is targeting to test…
“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was…
June 23, 2014

All Eyes on Texas

New York Yankees legend Yogi Berra once coined a phrase that seems to fit our present situation: “It’s déjà vu all over again!” The political fastball that none of us saw coming was whacked out of the proverbial ballpark a few weeks ago, with the implementation date of ICD-10 having…
As soon as Congress announced the latest ICD-10 implementation delay, healthcare industry leaders from across the country rallied together to face the facts (not to mention their collective disbelief and disappointment) and figure out how to move forward. First there was the April 30 ICD-10 Summit organized by the Workgroup…
At numerous meetings since the ICD-10 delay was announced, the chasm between large and small providers, entities, and practices has been evident. Obviously, some small groups are well ahead of the pack and some large groups are lagging, but the profound discrepancies keep reappearing. Stanley Nachimson recently commented on the…
Battered and bruised yet intact, like a dazed boxer entering a late round against an unrelenting challenger, the interim final rule for implementing ICD-10 by October 2015 limped into the federal Office of Management and Budget (OMB) last Friday.
Although narrow in scope, results from the ICD-10 National Testing Week conducted early last March revealed that the Centers for Medicare & Medicaid Services (CMS) accepted 89 percent of the test claims, with some regions reporting acceptance rates as high as 99 percent, according to CMS. The normal FFS Medicare…
(WASHINGTON: June 5, 2014)---The Senate today voted 78-17 to confirm Sylvia Burwell as the new secretary of the Department of Health and Human Services (HHS), replacing outgoing Secretary Kathleen Sebelius. In her new role, Burwell will assume ownership of the unwieldy ICD-10 initiative that has stalled four times as the…
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…