Featured Articles: Healthcare Reform

Ask Adele: Will the ICD-10 Changeover Really Happen?

Friday, February 13, 2015   (0 Comments)
Share |

Will the ICD-10 Changeover Really Happen?


By Adele Allison, Director, Provider Innovation Strategies, DST Health Solutions


Question:  Originally, the ICD-10 changeover was supposed to happen on Oct. 1, 2013.  Then CMS pushed it to Oct. 1, 2014, stating they would not delay it again.  But it got pushed a third time to Oct. 1, 2015!  With everything we have to do from meaningful use to UDS reporting to PCMH, I do not want to work preparing for a changeover that will never happen!  Will ICD-10 really happen this time?


Yours is a common question.  Unfortunately, there is no way to predict beyond a shadow of a doubt what tomorrow will hold, but a lack of planning and testing for ICD-10 may come back to haunt you.  The best answer I can provide is that CMS will not be moving the date.  As to Congress, there has been recent activity afoot to indicate Oct. 1, 2015 will stick this time.


What many do not realize is that the ICD-10 changeover was actually initiated by final rules issued under the Bush administration.  Collectively known as the “5010 Rules,” two regulations were finalized just days before President Obama took office to adopt updating the HIPAA standards.  The first rule required folks to move to the X12 Version 5010 for HIPAA electronic transactions by Jan. 1, 2012; and, the second rule replaced ICD-9 with ICD-10 by Oct. 1, 2013.  While the 5010 implementation occurred on time and was foundational to accommodate ICD-10, CMS pushed the ICD-10 compliance date by 1 year to Oct. 1, 2014.


The last change to Oct. 1, 2015, however, was made by Congress, not CMS.  Congress passed the Protecting Access to Medicare Act (PAMA) on Apr. 1, 2015 to address the Medicare sustainable growth rate formula and slipped in a delay of the ICD-10 implementation.  This date is almost six years after issue of the initial Bush regulation, seemingly more than an adequate amount of time to plan for the transition.


There have been two camps on the whole changeover issue.  In the “Pro” camp sit groups such as the American Health Information Management Association (AHIMA) and Healthcare Information and Management Systems Society (HIMSS).  Grounded in health IT, these organizations boast the benefits of the changeover, including:

·         Greater coding accuracy and specificity to communicate the nuance of your patient population

·         Increased data to measure quality, safety and security more accurately

·         Improved efficiencies and lower costs through reduced coding errors

·         Alignment with worldwide coding systems

·         Improved patient experience and elimination of waste, estimated at $1.2 trillion by PricewaterhouseCoopers

·         Alignment with the goals of clinical electronification under Meaningful Use


Sitting in the “Anti” camp are groups that include numerous provider organizations, the Medical Group Managers Association (MGMA) and the American Medical Association (AMA).  The arguments against the changeover include:

·         It is too burdensome, especially for small medical practices

·         It is too costly on physicians

·         It creates a high risk for payment delay

·         It is disruptive to provider health IT adoption efforts


On Wednesday, Feb. 11, 2015, the House Energy and Commerce Subcommittee on Health held a hearing entitled, “Examining ICD-10 Implementation.”  You can watch the hearing online.  While both camps were represented, the anti-camp was absent representation by the AMA and MGMA – two strong voices viewed as being responsible for the most recent delay.  In fact, “anti” ICD-10 was represented by a lone physician, William Jefferson Terry, MD, from the American Urological Association.


Following colleagues on the Twitterverse which buzzed with posts during and after the hearing, Dr. Terry used age-old arguments and lacked concrete facts to back up his statements.  Here are a few posts:





The Pro-camp panelists included broad industry representation such as physicians, a PM/EHR vendor (athenahealth), America’s Health Insurance Plans (AHIP), academia, and – of course – AHIMA and HIMSS.  These representatives used current data, such as the recent GAO report on CMS readiness and industry white papers showing lower-than-expected industry costs for implementation (average $3,430/provider) when compared to costs originally outlined by the AMA.  They discussed clearly and directly how the changeover to ICD-10 would support fraud detection, impact payment reform, and make reimbursement more equitable and accurate, and, essentially painted the picture of using a twentieth-century code set for twetny-first-century medicine.


If this Congressional hearing is any indication, I do not see another delay coming from Congress.  Anything is possible, but I hope you are prepared technically and culturally to move forward with ICD-10.


Do you have a question?  Let us know!  Contact membership@nwrpca.org to submit your questions to “Ask Adele.”

NWRPCA welcomes and regularly publishes white papers and articles submitted by members, partners and associates with subject matter expertise. The appearance of any guest publication in our Health Center News database represents the views of the author and does not constitute endorsement by NWRPCA of the stated opinions or perspectives, nor does it suggest endorsement of the contributor's products or services.

Membership Software Powered by YourMembership  ::  Legal