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Fact or Fiction, H.R. 2126 Could Kill ICD-10 Implementation?

Written by: Darlene D'Altorio-Jones (1959-2015) on Monday, July 6, 2015 Posted in: Acute Care Rehab

In 2008, the U.S. Department of Health and Human Services (HHS) issued a proposed rule to transition to ICD-10 on Oct. 1, 2011. Feedback received at HHS was that additional time was needed to prepare for the transition. In the 2009, HHS established that Oct. 1, 2013, would be the date for transition to allowing providers two additional years to prepare.

In 2012, as part of President Obama’s commitment to reducing regulatory burden, HHS moved the ICD-10 compliance date to Oct. 1, 2014, providing the industry with an additional year to work toward a successful transition.

Then on March 31, 2014 with the sustainable growth rate hanging at the sidelines for closure, the ‘Doc.Fix’ was passed by the senate in the latest hours possible to patch the sustainable growth rate formula that threatened a 24 % cut to Physician Fee Schedule payments; with that fix came the second official delay pushing ICD-10 implementation yet another year to Oct. 1, 2015.

While discussions of ICD-10 have been floating around the industry since the 1990’s and have been mentioned in proposed federal rules as early as 2005, it’s difficult to determine real advocates for change. ICD-10 promises improved diagnosis tracking of chronic illness and the underlying causes and complications of those diseases as well as the conditions that contribute toward complexity. Specifically, if CMS wants to fulfill the Three-Part AIM, and improve overall population health, tracking and understanding severity and stages of chronic kidney disease, diabetes and asthma through detailed coding is promising.

Despite those promises, legislators poke fun at the more obscure codes and use those random arguments to push an agenda toward further delay. Several times, Congress had published bills not just to postpone but to forbid ‘costly codes’ transition or ICD-10.

In the 113th Congress, H.R. 1701 and S. 972 were such bills. Neither left committee, but HR 1701 had 46 co-sponsors before it died. S. 972 only had 6 co-sponsors. But that was last year, and old news. What’s happening this year?

Some were looking for SGR action this year to delay or push ICD-10 one more time but when the Senate returned from their spring break and dealt with physician payment through the H.R. 2 in Mid-April, ICD-10 was not present in the bill.

Despite all indicators pointing to GO for Oct. 1, 2015, there is still resistance for change. How much longer will it take an industry of healthcare to prepare and HOW MUCH MONEY has been invested so far to keep the date intact? Millions, if not billions, have already been absorbed for education, training, health software upgrades and updates. And even if you have been ready for the past two years, how expensive is the continuous education to be certain staff maintain the skills to bring it all to fruition?

Yet again, there is H.R. 2126, called ‘Cutting Costly Codes Act of 2015’ introduced April 30, by Rep. Ted Poe of Texas. Although still in committee, every few days it gains a co-sponsor or two and is now up to 11. This bill would attempt, ‘To prohibit the Secretary of Health and Human Services from replacing ICD-9 with ICD-10 in implementing the HIPAA code set standards’. Yes, despite all the hard work already completed by the healthcare industry, it is believed plausible that scrapping ICD-10 entirely could be the way to go!

To that, I encourage people to share a great article written by Sue Bowman, RHIA, CCS called, “Why ICD-10 is Worth the Trouble”. Any legislator reading a coding specialists opinion would surely be more prepared to grasp the need for change.

A Government Accounting Office Report published in February 2015 was commented on by Orrin Hatch (R-Utah), Senate Finance Committee Chair, validating that CMS is on track and that the new coding system will streamline the management of healthcare records and improve patient care. He further went on to say he would keep a close eye on the issue and could see no reason for delay past the October deadline.  But that was before Representative Ted Poe put his argument back on the table as H.R. 2126.   What will you tell your representatives about this?

What do you think? Will it be full steam ahead or will Congress work to thwart the deadline one more time? How much have you invested in the change?

Is it ‘third time’s a charm’ or ‘three strikes you’re out’? Only time will tell.

Follow the CMS ICD-10 Web page – and countdown!  Now less than 90 days!

If we just need a grace period then Bill H.R.2652 is for you which could promise up to a 2 year extension to comply.  Will any of these pass committee?

Or is the latest discussion between AMA and CMS sufficient?  CMS will be lenient with errors as long as the correct family of codes are selected.  Stay in touch…just over 80 days til the switch in ON!

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