Health Information Compliance Alert

Published on Wed Aug 08, 2012 PDF

PQRS and meaningful use still key for EMR implementation.

Wondering how the Supreme Court's recent decision to uphold the constitutionality of the Affordable Care Act (2009), will impact you? Our experts have the answers.

Recall the History of ICD-10

The requirement to move toward the electronic format of 5010 and the ICD-10 code set was actually part of the HIPAA 1996 (Health Insurance Portability and Accountability Act of 1996) under the Clinton administration, says Suzan Berman, CPC, CEMC, CEDC, Senior Director of Physician Services at Healthcare Revenue Assurance Associates based out of Plantation, Florida.

"Parts of this Act have been implemented since then. With different push backs, the newest version of ASC 5010 was implemented in 1/1/2012. This was done to set the stage for ICD-10 with its new proposed implementation date of October 1, 2014 (still officially October 1, 2013 until an announcement is made)," Berman says.

But Obamacare, as it's been coined, doesn't include the ICD-10 code set. You should push forward with your ICD-10 assessments and implementation plans. Remember, "ICD-10 is a code set that we have known about since the World Health Organization first introduced it in the early 1990s. It will help to further define disease states, epidemics, trends, technologies, and other areas to research and study. Because it is a code set, we will also be using it for our insurance claim submissions. This is where the training of physicians and coders along with administrators is invaluable," Berman says.

Don't Forget PQRS

"Since the U.S. has never had a healthcare law that mandates everyone must have health insurance, I believe it is difficult to know or predict the effects it will have on providers and their practices," says Catherine Brink, BS, CMM, CPC, CMSCS, president of Healthcare Resource Management, Inc., in Spring Lake, N.J. "It is anyone's best guess right now."

But "don't forget the effects of PQRS," Brink warns. "Providers will be mandated to comply with entering patient medical data which translates to more administrative time for providers which means less time for patients."

"The procedures for claims submission and processing by insurance companies undoubtedly will be impacted with, again, volume," Brink predicts. "Billing staff time may increase to track claims and monitor reimbursement. Again more billing staff may be needed -- financial impact on practices. There is no doubt in my mind this law will have a definite impact on the doctor-patient relationship since the emphasis of the law is health insurance," she adds.

Another viewpoint: "The ACA should have little to no effect on Medicare's incentive plans, e-prescribing and PQRS. These plans will continue to be mandated in the future and monetary penalties imposed if these plans are not incorporated into practices. In addition, the Supreme Court's decision will have no effect on the 'Meaningful Use' rules established to aid physicians financially in their purchase and implementation of EMR technology," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, University Hospital, State University of New York, Stony Brook.