House Committee Meeting, Moving Forward with ICD-10

congressAny further delays with the Oct. 1, 2015 ICD-10 deadline would contradict the recent announcement by HHS to aggressively move forward with payment reform as most view ICD-10 as a critical building block.

On Wednesday, the House Energy and Commerce Committee held a hearing on ICD-10 with a number of payers, providers, industry groups, and vendors providing testimony. Despite a few dissenting views, the general consensus is the industry is ready for the ICD-10 transition and the federal government needs to firmly commit to the October 1 deadline to remove any lingering uncertainty that has been created after multiple delays from its original implementation date in 2011. Many of those testifying, including 3M Health Information Systems, AHIMA, and AHIP, stated ICD-10 is critical in order to move forward with value- or outcomes-based models, not to mention the anticipated benefits from more accurate payments, improved disease management, surveillance of pandemic threats, and the ability to reduce complications of care by more accurately identifying the factors and circumstances surrounding a patient and to accommodate new treatments and technologies such as minimally invasive surgery that have made ICD- 9 obsolete. The state of Maryland’s unique reimbursement system, emphasizing prevention and quality, was referenced as a future model.

Reasons against moving forward were made by a small group practice and the American Urological Association and centered on physicians being overwhelmed by the “tsunami” of regulations, the risk to cash flow as denials increase and DAR spikes, the greater cost associated with education and more robust documentation, and ultimately the potential for even higher audit risk given the complexity and specificity of ICD-10.

In late January, for the first time HHS set explicit targets for payment reform by declaring its goal of 30% of fee-for-service Medicare payments to be linked to quality or value through alternative payment models (e.g., bundled payments or accountable care organizations) by the end of 2016 and 50% by the end of 2018. Based on its aggressive timeline for payment reform, momentum seems to be building for the transition to ICD-10 to finally happen in 2015.

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