ICD-10 Delayed: Now What?
[Road Map to ICD-10]
Continue preparing, keep calm, and code on.
By Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC
The delay of ICD-10 to no earlier than October 1, 2015 prompted many changes throughout the healthcare industry, as well as for AAPC members. Here is an explanation of how the delay happened, and what it means for you.
What We Know About the Delay
The sustainable growth rate (SGR) methodology has been used to calculate the Medicare Physician Fee Schedule (MPFS) since 1997. Almost every year, for more than a decade, Medicare expenditures have surpassed targets, and the SGR has called for substantial cuts in provider payments.
Every year since 2003, Congress has intervened to prevent the SGR-mandated reductions. The deferments do not abolish the SGR; instead, they allow mandated payment cuts to accumulate. Previous legislation to forestall SGR mandated cuts (passed just hours before Christmas 2013) was set to expire April 1. Without immediate Congressional action to replace or amend the SGR, providers faced cuts in Medicare reimbursement of nearly 25 percent.
On March 26, Representative Joseph R. Pitts (R-PA) introduced the “Protecting Access to Medicare Act of 2014” (H.R.4302), which served as yet another temporary “patch” to the SGR. At the last minute, language was added to H.R.4302 to delay implementation of ICD-10 to no sooner than October 1, 2015 — or, at least one year later than had previously been mandated. Only a few weeks earlier, the Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner had publicly insisted that there would be no further delays to ICD-10, but because no one wanted to see the drastic cuts in provider reimbursement happen, passage of H.R.4302 was assured almost from the start. President Obama signed H.R.4302 into law (which has since become know as the “Doc Fix”) on April 1.
The further delay of ICD-10 has caused mixed feelings within the healthcare industry, including among AAPC members. Many healthcare professionals at every level have invested significant resources in anticipation of the October 2014 implementation. They made their due diligence and were frustrated by further delay. Others knew that even though they might personally be ready for ICD-10, their practice, facility, or vendor would not be. They may have felt a sense of relief, as certainly did those individuals and facilities that had not yet begun to prepare, and those who had opposed ICD-10 all along. The reaction that everyone shares is one of uncertainty. The delay of ICD-10 has left all of us in the healthcare industry wondering: What now?
Here’s AAPC’s recommended plan, moving forward.
Training, Education Opportunities Extended
If you have received your education from AAPC (or you plan to by September 30, 2014), AAPC has extended your online access to ICD-10 courses to December 31, 2015. We also are offering free refresher webinars for those taking our ICD-10-CM or ICD-10-PCS educational courses.
For physicians enrolled in our ICD-10 documentation training in the aforementioned time parameters, course access has been extended until December 31, 2015.
New Proficiency Assessment Timeline
For those credentialed members who are required to demonstrate proficiency in the ICD-10-CM code set, the timeline has been adjusted to December 31, 2015.
There are many ways you can continue or start to prepare, such as using AAPC’s free/low cost resources, including:
- Local chapter meetings
- AAPC ICD-10 Implementation Tracker tool
- AAPC ICD-10-CM coding resources
- AAPC ICD-10 Town Hall webinars
- ICD-10 Connect newsletters
- Implementation whitepapers
Continue with Preparation
Given the current uncertainty, you may be wondering why you should continue preparing for ICD-10. In AAPC’s estimation, there are compelling reasons to do so, and here are four of them:
To Move the Industry Forward – Testing and training are important pieces of implementation. Without proper testing, practices will put themselves at financial risk if claims are unable to be processed when ICD-10 does come to fruition. But practices can’t test if you are not trained. Training will move the industry forward.
Documentation and Financial Improvement – Clinical documentation is not only an important facet of ICD-10 implementation, but also effects many other initiatives and programs. Time is needed to work with physicians to bring documentation in compliance, and to develop tools and template solutions. Effort invested in improving provider documentation will pay immediate dividends in improved patient care, claims acceptance, and provider reimbursement — regardless of which coding system (ICD-9 or ICD-10) is in use.
Compliance – Preparing for ICD-10 helps to keep your practice in alignment with all the other initiatives, and helps to bring your practice into better compliance.
Knowledge Is Power – No matter what your role is in ICD-10 implementation, education is not wasted. For example, by learning ICD-10, you become a stronger ICD-9 coder.
Coders and other healthcare professionals should receive training so they can be ready to go, whenever ICD-10 is implanted. Don’t assume the current delay is permanent. Take advantage of the opportunity to improve your preparation — for instance, to help prepare for and alleviate the initial, decreased productivity that ICD-10 is expected to bring. Don’t let uncertainty turn into inaction. Keep calm and code on.
Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, is vice president of ICD-10 Training and Education at AAPC.