At 6:41 last evening, with 64 YEAs and 35 NAYs, the U.S. Senate passed the Protecting Access to Medicare Act of 2014. The bill, which was designed to suspend the sustainable growth rate formula that would have cut physician reimbursement rates by nearly 24 percent and further delay Medicare cuts to physicians until April 1, 2015, also included a provision to delay the transition from ICD-9 to ICD-10 code sets to 2015.
Sec. 212 - The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD–10 code sets as the standard for code sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d–2(c)) and section 162.1002 of title 45, Code of Federal Regulations.
Impact on SGR
The temporary fix for the SGR was necessary (and happens every year). A 24% reduction in Medicare payments would have been catastrophic for the industry and resulted in millions of physician practices going out of business. But the fix is just that – temporary. The formula that drives SGR is fundamentally flawed and the entire structure needs to be completely overhauled. But fixing the formula creates a large budget gap and figuring out how to pay for that gap is keeping any long-term fix at bay. Since greater than half of the reimbursement physician groups and hospitals receive incomes from Medicare, it is incredibly important that stability is brought to this process.
Impact on ICD-10 Implementation
Much like the fix to the SGR formula is necessary, so too is the transition to ICD-10. ICD-9 is an antiquated coding system that has been pushed to its limits. Since ICD-9 was introduced, 30 years ago, new procedures, new techniques and even whole new disease categories have emerged. The shift to ICD-10 is needed to support the ongoing evolution of medicine, to facilitate more sophisticated medical research and to identify and avoid emerging global health threats.
The delay is also a disappointment to an industry that has already made significant investments to prepare for the transition. This new legislation leaves many wondering how the delay will impact their efforts.
eMDs was disappointed to hear that Congress approved the ICD-10 delay. We support the industry transition to ICD-10 and believe it is necessary.
We have been working diligently to prepare our clients for transition. We applaud our client’s efforts in preparing for this daunting effort and are empathetic to the frustration this delay has caused.
However, we believe with each setback comes opportunity.
MDeverywhere remains committed to helping our clients successfully navigate the transition - regardless of when it happens – and has no plans of slowing down. To that end, we remain steadfast in our promise to be ready for the original October 2014 deadline. This will give our clients a unique opportunity to work with and understand the coding changes a full year in advance.
Our solution includes robust ICD-10 coding features including:
- An ICD-10 Look Up Feature allowing users to easily look up the new codes that will replace ICD-9. Ensuring the correct code for each encounter is key to minimizing negative impact to cashflow in the coming months.
- An ICD-10 Demo sandbox is live providing medical staff a safe place to familiarize themselves and get comfortable with the ICD-10 code changes specific to their specialty without concern of corrupting live patient data.
- Two Code Search fields – one specifically for procedure codes and the other for diagnosis codes to accommodate the 69,000 ICD-10 codes.
- Access to MDe University, an online training portal offering 18 self-paced courses that cover each feature and functionality of the Practice 1st tool.