ICD-10: Q&A

ICD-10 RedThere’s been a lot of buzz in the press recently about the upcoming ICD-10 deadline. Will it happen? Will Congress create another delay? For some insight on the situation, we reach out to eMDs for their perspective.

Q: Why do you think we will transition to ICD-10 on October 1st? What's different this time?
A: Momentum, confidence, and the push toward value-based payments. In late January, for the first time Health and Human Services 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 is building for the transition to ICD-10 as most view it as a critical building block. In February, 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 deadline to remove any lingering uncertainty that has been created after multiple delays from its original implementation date in 2011. The next big hurdle to a 2015 transition happened March 26th when the house overwhelmingly approved the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This was the last legislative opportunity for Congress to postpone the delay.

Q: We are closer than ever to transitioning to ICD-10, but isn’t it possible that Congress could still derail efforts?
A: True, nothing is 100%. The Senate could throw in a last minute amendment to MACRA and suddenly we’re delayed for another year. But, we believe that option to be highly unlikely. Remember, MACRA’s main intent is to fix the SGR formula. The current legislation expired April 1st and with that physicians face a 21% cut in payments. CMS has delayed processing claims in order to keep the cut from being implemented but this is a temporary hold. This will put tremendous pressure on the Senate to act quickly when they get back from recess. All indications are that the Senate will pass the bill when they return and the President has also publicly expressed his support for the legislation.

Q: WEDI latest research shows an industry even further behind the recommended timelines than it was before the delay. At the same time, the consensus at this point actually seems to be we should push forward and keep the Oct 1. 2015 compliance date. So, really, what is different this time?
A: By all measures, the change will be a big one - potentially catastrophic for the unprepared. The transition will affect everything about documenting and billing for the care of patients. And there are compelling reasons against moving forward - 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. But, ICD-10 is an inevitability. It is critical in order to move forward with value-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 healthcare industry has received a number of reprieves but now is the time to push forward.

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