Wiki Congress to vote on delay March 27, 2014

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Wanted to share this article so all can contact their state representatives:
Congress to Vote on ICD-10 Delay Tomorrow, AHIMA Calls for Action to Stop Bill Today

Mar 26, 2014 11:04 am | posted by Chris Dimick | Coding & reimbursement & ICD-10
A new bill has been quietly introduced into the US House and Senate that features a section calling for the delay ICD-10-CM/PCS implementation until 2015.

The bill, which would adjust the Sustainable Growth Rate (SGR) and amend the Social Security Act to extend Medicare payments to physicians and change other provisions of the Medicare and Medicaid programs, also includes a seven line section that would delay ICD-10 to October 1, 2015.

This bill was negotiated at the leadership level in the House and Senate, and it is expected that there will be no debate before calling the bill to vote. The bill states: ?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 13 Social Security Act (42 U.S.C. 1320d?2(c)) and section 14 162.1002 of title 45, Code of Federal Regulations.?

This bill is expected to go to the House floor on Thursday, March 27 for a vote.

AHIMA Calls on Members to Request Removal of Delay Provision
AHIMA has put out a call to members and other stakeholders to contact their representatives in Congress and ask them to take the ICD-10 provision out of the SGR bill.

When contacting Congressional members, AHIMA has instructed callers to state that their representatives/senators:

?Oppose the specific language in the SGR patch legislation
?Reach out to the Speaker of the House John Boehner and Senate Majority Leader Harry Reid to remove the ICD-10 language from the bill
AHIMA officials have said that another delay in ICD-10 will cost the industry money and wasted time implementing the new code set. Groups opposing ICD-10 have said that the implementation, with its large increase in codes and need to adapt healthcare systems, causes an unnecessary burden on providers.

CMS estimates that a one year delay could cost between $1 billion to $6.6 billion, according a statement from AHIMA officials. ?This is approximately 10-30 percent of what has already been invested by providers, payers, vendors and academic programs in your district,? AHIMA wrote in a statement. ?Without ICD-10, the return on investment in EHRs and health data exchange will be greatly diminished? Let Speaker Boehner and Senate Majority Leader Reid know that a delay in ICD-10 will substantially increase total implementation costs in your district.?

Contacting Your Congressional Representatives
For more information on contacting your representatives and senators in Congress, visit AHIMA?s Advocacy and Public Policy representative look-up site at http://capwiz.com/ahima/dbq/officials/. For more information on AHIMA ICD-10 advocacy, visit http://www.ahima.org/about/advocacy
 
Thanks for sharing this. I was going to do so, but was beaten to the punch! Regardless of your stance (IMO, it's time to stop the games and get it done), reaching out to your Congressional representatives is what you should do if you care at all about ICD-10.
 
Called my Congress Woman and Wrote My Doctor's Congressman

I just got off the phone with Congress woman, Kuster......was on the phone for at least 5 mins explaining to the poor girl that answered the phone....about how important ICD10CM coding is and that the US needs to get on the stick and come up to speed!!

Call, E-mail, whatever....contact your Congress now, tonight!!!:eek:

jlm said:
Wanted to share this article so all can contact their state representatives:
Congress to Vote on ICD-10 Delay Tomorrow, AHIMA Calls for Action to Stop Bill Today

Mar 26, 2014 11:04 am | posted by Chris Dimick | Coding & reimbursement & ICD-10
A new bill has been quietly introduced into the US House and Senate that features a section calling for the delay ICD-10-CM/PCS implementation until 2015.

The bill, which would adjust the Sustainable Growth Rate (SGR) and amend the Social Security Act to extend Medicare payments to physicians and change other provisions of the Medicare and Medicaid programs, also includes a seven line section that would delay ICD-10 to October 1, 2015.

This bill was negotiated at the leadership level in the House and Senate, and it is expected that there will be no debate before calling the bill to vote. The bill states: ?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 13 Social Security Act (42 U.S.C. 1320d?2(c)) and section 14 162.1002 of title 45, Code of Federal Regulations.?

This bill is expected to go to the House floor on Thursday, March 27 for a vote.

AHIMA Calls on Members to Request Removal of Delay Provision
AHIMA has put out a call to members and other stakeholders to contact their representatives in Congress and ask them to take the ICD-10 provision out of the SGR bill.

When contacting Congressional members, AHIMA has instructed callers to state that their representatives/senators:

?Oppose the specific language in the SGR patch legislation
?Reach out to the Speaker of the House John Boehner and Senate Majority Leader Harry Reid to remove the ICD-10 language from the bill
AHIMA officials have said that another delay in ICD-10 will cost the industry money and wasted time implementing the new code set. Groups opposing ICD-10 have said that the implementation, with its large increase in codes and need to adapt healthcare systems, causes an unnecessary burden on providers.

CMS estimates that a one year delay could cost between $1 billion to $6.6 billion, according a statement from AHIMA officials. ?This is approximately 10-30 percent of what has already been invested by providers, payers, vendors and academic programs in your district,? AHIMA wrote in a statement. ?Without ICD-10, the return on investment in EHRs and health data exchange will be greatly diminished? Let Speaker Boehner and Senate Majority Leader Reid know that a delay in ICD-10 will substantially increase total implementation costs in your district.?

Contacting Your Congressional Representatives
For more information on contacting your representatives and senators in Congress, visit AHIMA?s Advocacy and Public Policy representative look-up site at http://capwiz.com/ahima/dbq/officials/. For more information on AHIMA ICD-10 advocacy, visit http://www.ahima.org/about/advocacy
Click to expand...
 
ICD 10 Delay proposed again by Congress

The Bill is HR4302 being called ??Protecting Access to Medicare Act of 2014??. Hidden is "Sec. 212. Delay in transition from ICD?9 TO ICD?10 code sets. "
Congress is voting on the entire group of proposals without a discussion on Thursday 3/27.
Funny as I checked the A.M.A. web site they are pushing this delay again, but the blog of many of their own physicians actually support the current October 2014 start.
We have been using ICD 9 since 1975. Medical procedures drugs and care have changed since then. The World Health Organization (WHO) implemented ICD 10 coding world wide in 1994.
Just as interesting to me was "Sec. 213. Elimination of limitation on deductibles for employer-sponsored health plans. "Guess this is what happens while we are not watching congress. (wonder who could be behind this idea? you got it!) I did call congress and left my professional opinion with several of them as well as my local Senator. They all have VMs and web sites. :)
 
I am saddened and sick of this kind of underhanded tactic. I wonder how many of those voting even understand the significance of the seven lines pertaining to ICD-10 CM. All of the prep and hard work that all of us have invested on this only to be tabled yet another year??!!! We were promised, yes promised last year that there would be no further delay and it would not even be considered. I cannot even imagine what these people are so afraid of. This sytem works better and more clear and is easier than ICD-9. I shake my head and worry about the future of health care in the US!
 
Debra, not last year - just last MONTH, Secertary Sebellis said no more delays. I have not only written email to my House Representative (Rep. Chris Gibson) and two Senators (Kirsten Gillibrand and Chuck Schumer) but also to House Speaker Bohener and Senate Majority Leader Reid. Sure, maybe it falls on deaf ears but we all need to do our part to make our views heard.

I am not optimistic - with the MGMA and AMA complaining loudly, I am sure that Congressmen don't want to hear about more healthcare issues a month before the mid-term elections. Like you said, all our work to get ready for this is now being delayed again. ARRRGGGHHH!!!
 
Delay for ICD-10

Good morning

When we received the word yesterday on this, they stated in the AHIMA letter that this could cost between $1 billion-$6.6 billion dollars if this is delayed from CMS. I read the bill and it is 121 pages long. If you go to section 212 under Title II-Other Health Provisions on page 19. The entire bill is to amend the Social Security Act to extend Medicare payments to physicians and other provisions of the Medicare and Medicaid programs, and for other purposes. It mentions Delay in transition from ICD-9 TO ICD-110 code sets. It is a very small paragraph.

Since I have been working on ICD-10 for the past 6 months, we would feel that all the work that has been done with only 6 months left until implementation would be detrimental to physicians, coders, hospitals, etc.... across the nation.

Please help stop this motion.
 
It's time for ICD-10!!!
We are as prepared as we are going to be. And whoever wrote that more education needs to be given to those passing these bills is absolutely correct. ICD-9 was supose to be temporary. It is time we catch up to the other countries already using I-10.
 
I agree, we need to go ahead with this thing...but my primary worry is that some of the PAYERS are not going to be ready in time...that's the feedback I am getting from a few payer reps (I won't name names)

That could result in serious delays in processing claims which would negatively impact our income that way.

So it would seem we are danged if we do and danged if we don't....but I'll put in a call to add my voice to the "go ahead with this thing already" crowd.

As an aside: This is one main reason I have delayed getting ICD-10 certified. It doesn't do me much good if they delay implementation yet again...and you end up not using your new knowledge for a whole year and then wind up forgetting most of what you learned, because you're not USING it.

I don't believe the basic rules of coding are actually changing as much as the codes themselves...the same basic E/M rules are not changing.
 
ABridgman said:
I agree, we need to go ahead with this thing...but my primary worry is that some of the PAYERS are not going to be ready in time...that's the feedback I am getting from a few payer reps (I won't name names)

That could result in serious delays in processing claims which would negatively impact our income that way.

So it would seem we are danged if we do and danged if we don't....but I'll put in a call to add my voice to the "go ahead with this thing already" crowd.

As an aside: This is one main reason I have delayed getting ICD-10 certified. It doesn't do me much good if they delay implementation yet again...and you end up not using your new knowledge for a whole year and then wind up forgetting most of what you learned, because you're not USING it.

I don't believe the basic rules of coding are actually changing as much as the codes themselves...the same basic E/M rules are not changing.
Click to expand...

Agree with your logic in not going too far ahead with certified - I have done the same thing for the same reason. I have been skeptical it would happen until I actually saw it on Oct. 1 - this is the government after all. Also, if you are comfortable with an ICD-9 book and looking up codes in the alphabetic index and then in the tabular - ICD-10-CM is pretty much the same. Yes, more detailed, but you still arrive at the correct code in the same way.

ICD-10-PCS, now, that's another ball game....
 
Thank you April ! I was trying to watch this live and i missed this when i left the room for a second. So this bill has been tabled for now. I have communicated with my representative and my senator. I also sent an e-mail to Rep Pitts. He is the sponsor of this hill., i requested that he eliminate this section pertaining to ICD-10 and I will then encourage my representative to vote for the bill. We have a little time to work with so we need all of use to get involved and contact your representative and senator and help to get this done.
 
It passed by a voice vote:


In voice vote, House approves Medicare ?doc fix?

By Wesley Lowery, Updated: March 27 at 12:42 pm

The House quickly approved another so-called "doc fix" bill early Thursday afternoon that serves as a temporary solution to an ongoing structural problem in the formula used to determine Medicare funding levels.

After hours of uncertainty over whether the bill have sufficient support to pass, House Republican leaders moved quickly to approve the measure by voice vote.

The bill, which is also expected to be taken up and passed by the Senate later Thursday, prevents a 24 percent cut in reimbursements to physicians under Medicare.

House Democrats criticized the bill -- insisting that Congress should have voted on a permanent fix to the Sustainable Growth Rate model.

"This is a band-aid," declared House Minority Leader Nancy Pelosi (D-Calif.) during a speech before the vote. " There are so many things that are wrong with this bill, but the simple fact is that the clock is ticking and on March 31, it's bad news for our seniors and the doctors that treat them."

The "doc fix" is the latest incarnation of a bill passed frequently by the House -- sometimes multiple times per year -- that avoids a sharp drop-off in Medicare payments.

In 1997, Congress created the Sustainable Growth Rate, a system that pegged the amount of money budgeted for Medicare payments to projected growth of the economy. However, within a few years, health-care costs far outpaced economic growth -- creating a multibillion dollar shortfall in funding for Medicare payments.

Since 2003, Congress has approved "doc fix" bills that appropriate more money to Medicare funding in order to avoid cuts in Medicare reimburse rates for doctors.

The last doc fix bill expires on March 31, forcing Congress to either pass another doc fix, pass a bill overhauling Medicare payments, or see skyrocketing costs of doctors who treat Medicare patients.

This year's legislation, also includes a new delay to Medicaid cuts to hospitals serving low-income patients that were ordered by the Affordable Care Act.

"We need to fix this permanently, not patch it every year." said Rep. Steny Hoyer, (D-Md.), the House Minority Whip. "It's a fraud and both sides have committed that fraud. We have to fix this."

? The Washington Post Company

http://www.washingtonpost.com/blogs...n-voice-vote-house-approves-medicare-doc-fix/
 
So one source says it passed and the other says it was postponed so which is it?? If it was voted on even a voice vote we should be able to see who voted which way. I at the other bill voted on and there is a detailed accounting of the yeas and nays. There is nothing on this one. But it does not look good.
 
March 27, 2014
House Votes to Delay ICD-10 Implementation
By Chuck Buck
The fix is in.
The U.S. House of Representatives voted today to extend the deadline for implementing ICD-10 by one year, pushing the mandatory compliance date to October 2015. The Senate is expected to vote tomorrow.
The provision for extending the delay was tucked into the House bill to extend the Sustainable Growth Rate (SGR) formula for another 12 months rather than finding a permanent solution to the 1997 Balanced Budget Act, which attempted to rein in Medicare reimbursement to physicians. Annual "doc fixes" to temporarily repeal the SGR have become an existential rite of spring, as Congress has continued to forestall a scheduled 24-percent reduction to physician reimbursement that would have kicked in April 1.
Read more?


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http://clerk.house.gov/floorsummary/floor.aspx gives the official trasncript - it was passed by voice vote. This is the excerpt from that site for the bill:

12:08:20 P.M. H.R. 4302 Considered as unfinished business. H.R. 4302 ? "To amend the Social Security Act to extend Medicare payments to physicians and other provisions of the Medicare and Medicaid programs, and for other purposes."

12:09:00 P.M. H.R. 4302 On motion to suspend the rules and pass the bill Agreed to by voice vote
 
mitchellde said:
So one source says it passed and the other says it was postponed so which is it?? If it was voted on even a voice vote we should be able to see who voted which way. I at the other bill voted on and there is a detailed accounting of the yeas and nays. There is nothing on this one. But it does not look good.
Click to expand...

I don't think you would know individual votes on a voice vote alone. If there is a question of whether there are more yays than nays, then the Speaker would call for individual votes, but if one side is much louder than the other when the vote is cast, then the bill would pass or die without having to count individual votes. So, best guess would be this was a resounding yes vote.
 
I was so afraid of that. We can only hope that with a democratic majority Senate this will not pass. But with this week being spring break in many areas how many of our representatives and senators are even present. This is very bad for our industry. To be saddled with an outdated code set for yet another year when the majority of us have invest valuable time and money into the learning and mastery of this new code set.
 
ICD-10 Moved to 10/2015 House of Representatives PASSED the Bill

It passed!! (pending Senate approval on 03/31/14-CALL YOUR SENATOR)!!

American Institute of Healthcare Compliance
Alert Update
Thursday March 27, 2014

House of Representatives PASSED the Bill to amend the Social Security Act on important health care issues

Check out this link:
http://campaign.r20.constantcontact...WAg52G9xY4zByjnCbH11FvT6RDm20lpEIGjuuxTyvUvc=
 
MnTwins29 said:
Agree with your logic in not going too far ahead with certified - I have done the same thing for the same reason. I have been skeptical it would happen until I actually saw it on Oct. 1 - this is the government after all. Also, if you are comfortable with an ICD-9 book and looking up codes in the alphabetic index and then in the tabular - ICD-10-CM is pretty much the same. Yes, more detailed, but you still arrive at the correct code in the same way.

ICD-10-PCS, now, that's another ball game....
Click to expand...

PCS only matters if you're doing Institutional claims, not Professional Claims.
So no worries for me, yet, regarding ICD-10 PCS. But it might be a good idea to get a general working knowledge of it...once they actually implement it!
 
Inpatient, outpatient and professional

I audit inpatient and outpatient records as well as professional claims, so I have had to go through PCS training as well. That was just starting - now I wonder if it will be on hold if the Senate passes this as well!
 
MnTwins29 said:
Great article and it just goes to illustrate that our government leaders really have no clue just what we are doing regarding physician pay or ICD-10 (if any of them even knew about that seven-line sentence).
Click to expand...

Our government leaders have no clue about ANYTHING regular folks like you or I do at all. They have the Beltway Syndrome...they exist in a bubble where the rest of us do not, and they lose touch with us as a result.

We could explain to them WHY this is important to us and they likely would not care. Their Job Number One anymore is to get re-elected. And they believe that "he who has the most cash wins" in any election, so they are going to listen to whomever comes to them with the most money.

Oh, they'll TELL you that they care, but the truth is they are clueless and don't care to get a clue, either.

Not that this should stop any of us from still calling our Senators. My calls to Casey and Toomey go out today. Too late for Cartwright.

P.S. - As someone who has some experience as a citizen lobbyist, it is always a good idea to let them know exactly what you're talking about...to that end, the Senate Bill is S 2157.
The House Bill which passed was HR 4302.

Me, I intend to express concern to my Senators over the passage of the HR....and urge striking the implementation delay from S 2157.

If JUST the Senate passes a bill that strikes ICD-10 implementation delay, then what happens is a conference committee to coordinate the bills, so that they match. That is our best chance. We need to get the Senate to pass the bill, but strike the delay of ICD-10 from it.

Because this bill DOES need to pass, else we could see Medicare payments drop precipitously, which would also create problems.

So be specific, that we want the bill to pass, but WITHOUT the ICD-10 implementation delay.

Hopefully, then, it will go to Conference Committee. This is mind, it would not be a bad idea to still call House Members about this.
 
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Better 'brand' a VETO on this if it does pass the Senate

So if we are all ready- why can't we talk to our vendors and CMS and go through with the original deadline since the ones making these decisions have no idea what we have all gone through to get to this level. Who is standing in our way?
As a member of a 'small rural hospital'- we are ready and don't like that the blame is being shifted in our direction. I am quite sure that all the members of 'Small Rural Hospitals' in Montana are ready so I don't believe they polled us. What about the other states with 'small rural hospitals'? I know you're ready- the pride for these facilities we all have, makes me optimistic that we are prepared but getting the blame for the delay. Don't believe it. Call your Senators. Or maybe we can have former Montana Gov. Schweitzer drop off his 'Veto' Branding iron off with the President.
 
Cady,
As far as I can tell, there is nothing that would prevent anyone from going ahead with ICD-10 with any PRIVATE PAYER. However, the bill's language specifically forbids CMS from taking any action without Congressional approval. Meaning that, even if we are ready and they are ready...the implementation would be delayed and CMS cannot over-ride that delay.

I have calls in to both my Senators, Pat Toomey and Bob Casey. Have not yet heard back from their Legislative Assistants on this yet (and by the way folks...when you call, THAT is who you want to talk to...a Legislative Assistant)

I did, however, speak with Congressman Matt Cartwright's office, and left a message for his Legislative Assistant to get back to me...and in this case, since I had a knowledgeable person on the line, I attempted to outline for them what my strategy is.

Folks: I don't mean to speak for anyone but myself, but, I think it is in ALL of our best interests that the overall bill DOES pass - otherwise we will all see provider payments from Medicare drop very badly. Bad enough we have to deal with Sequestration cuts!! However, we don't want the delay of ICD-10 to happen.

That is why the absolute best strategy we can do right now, in my opinion...is to call Senators and encourage them to pass the bill...but WITHOUT the ICD-10 implementation delay. That will cause two different versions of the bill to be passed, thus they will have to have a Conference Committee between the two Chambers to iron out the differences.

What we DON'T want is identical bills to pass the Senate and House...because then we have virtually zero chance.

Meanwhile, we should be calling our House Members (the ones who already passed the bill) and explain our position concerning ICD-10. Hopefully, we can get a few allies on our side in Conference Committee...and get this particular part taken out of the final bill which would then go to Obama for signature or veto.

I sincerely doubt that...even if implementation delay is passed...that Obama would veto this bill...so our best chance is to amend it at the Senate level now...and then have the final bill coming out of Conference Committee to not include the implementation delay.

THAT, I believe, is where we all should be on this legislation, and it is best if we are presenting a unified voice in this matter. This serves everything we DO want...and nothing we DON'T want.

This allows for the Medicare payments to providers to remain at current levels...while also not delaying ICD-10 implementation.

Although, in my not so humble opinion...Steny Hoyer of MD has it right...we need to fix this thing right and not have a SGR bill every year, just slapping a band-aid on the problem...which goes all the way back to 1997.
 
ABridgman said:
Our government leaders have no clue about ANYTHING regular folks like you or I do at all. They have the Beltway Syndrome...they exist in a bubble where the rest of us do not, and they lose touch with us as a result.

We could explain to them WHY this is important to us and they likely would not care. Their Job Number One anymore is to get re-elected. And they believe that "he who has the most cash wins" in any election, so they are going to listen to whomever comes to them with the most money.

Oh, they'll TELL you that they care, but the truth is they are clueless and don't care to get a clue, either.

Not that this should stop any of us from still calling our Senators. My calls to Casey and Toomey go out today. Too late for Cartwright.

P.S. - As someone who has some experience as a citizen lobbyist, it is always a good idea to let them know exactly what you're talking about...to that end, the Senate Bill is S 2157.
The House Bill which passed was HR 4302.

Me, I intend to express concern to my Senators over the passage of the HR....and urge striking the implementation delay from S 2157.

If JUST the Senate passes a bill that strikes ICD-10 implementation delay, then what happens is a conference committee to coordinate the bills, so that they match. That is our best chance. We need to get the Senate to pass the bill, but strike the delay of ICD-10 from it.

Because this bill DOES need to pass, else we could see Medicare payments drop precipitously, which would also create problems.

So be specific, that we want the bill to pass, but WITHOUT the ICD-10 implementation delay.

Hopefully, then, it will go to Conference Committee. This is mind, it would not be a bad idea to still call House Members about this.
Click to expand...
Correct the bill number now changes and I spok with my daughter who is an attorney for Heath and Human services in DC, she did say there is time to contact your senator and request that the ICD-10 CM provision be removed, the bill does need to pass with that exception. She stated then if they do amend it the house has to consider that amendment and then if they pass it it goes to the President who can pass or veto. Nancy Pelosi was not please with the manner this done but did get behind the bill since the rest of it is necessary. Most of the senators and representatives have no idea what ICD-10 CM even is much less how much work has gone into preparation. Therefore if you get behiund the bill and request only that portion removed we have a better chance for success.
 
It passed. Now it goes to obama to sign or veto. We need to get him to veto this bill!!!!!!!!
 
mjs1974 said:
It passed. Now it goes to obama to sign or veto. We need to get him to veto this bill!!!!!!!!
Click to expand...

Wrong.

Veto would result in Medicare payments to providers being cut by as much as 24 percent. The overall bill needs to pass.
Just not the part about delay of implementation.

If it passed the House but not yet the Senate, then we still have a chance.

If it passes the Senate with the delay intact...then we are in trouble. In which case, given a choice between a year delay of ICD-10...or 24 percent cut in payments, I'll take the delay.

Besides, I am reasonably sure that there's no way in all the seven hells that Obama is going to veto this one. Even as a lame duck President, he isn't going to. This would be spun by the muckrakers and pundits as cutting funding to Medicare and used against the entire Democratic Party in upcoming mid-term and 2016 Presidential elections.

Just telling you how things really work in Washington. As a person with experience in citizen lobbying, I am telling you our best chance is to go for the Senate...get them to pass the bill WITHOUT the implementation delay...and then get the final bill out of Conference Committee to not include the implementation delay.

ADDENDUM: Thus, if we are successful in getting the Senate to drop implementation delay from the Senate bill...we still need allies in the House to get that to carry thru to the final bill which would then go to Obama.

So don't forget to also still call House Members...even if they supported the original HB 4302.

I believe the Senate votes on 2157 tomorrow.
 
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OK, folks....

Just got off the phone with John, a Legislative Aide with Senator Bob Casey's office...and he was able to give me the straight dope, and it doesn't look good...

S 2157 is a bill sponsored by Senator Wyden of Oregon. It is set to be voted on on Monday, 3/31. While Casey does support this bill, John indicated to me he does not believe it likely to pass. (2157, by the way...is the solution Steny Hoyer-MD, indicated he would have preferred over what in fact came out of the House)

Now...here's where this gets tricky, so I'll try to lay it out for you as best I can in layman's terms:

S 2157 calls for the repeal and replacement of the Sustainable Growth Rate. This is a problem that goes all the way back to 1997...and every year, the Congress has slapped a band-aid on the issue, passing extensions to this.

THAT is what the vote on HB 4302 was about. And this was a "patch" which was negotiated within the House and then passed. That bill includes the ICD-10 implementation delay.

(I am not clear on how the implementation delay came to be a part of this patch, but I can advance a few guesses - as I had indicated before, I had gotten wind from some of my Provider Reps with some of my Payers...that some of the payers would not be ready for ICD-10 in time for October 2014...and my guess is that some of these payers are political campaign contributors - reference my earlier posts about this...and you can do the math)

S 2157, however, does NOT include an implementation delay. Senator Casey, incidentally, supports 2157 and supports 2014 implementation of ICD-10.

The thing is, as it looks now, 2157 is not going to have enough support to pass. Which means that the Senate will then vote on 4302 instead.

(My guess on the reasons for this is - quite simply, some payers are pushing against 2157...and pushing for 4302 - if you want to know why things happen as they do in Washington, the best way is to follow the money trail)

AND THERE IS NO WAY TO REMOVE THE IMPLEMENTATION DELAY FROM 4302 FOR PURPOSES OF THE SENATE...they will have to vote on it as is. And if it passes, it goes to Obama - who will sign it...I explained why he will NEVER veto this one in an earlier post.

A lot can happen tomorrow and over the weekend, but as it looks now, 2157 won't pass, and the Senate will instead vote on 4302, and then that will go to Obama to be signed, and we will have delay of ICD-10.

Unless, of course, miracles happen, and 2157 actually passes.

The upshot of all this is: There is NO WAY that either the D's or the R's are going to allow it to get hung on them, in an election year...that they supported any cuts to Medicare (which is what a no/veto vote would get spun as being...even though it isn't) which means ONE of these two bills are going to get passed, and get signed by the President.

If 2157 makes it...no delay to ICD-10 implementation, and no cuts to provider payments.

If 4302 makes it...ICD-10 gets delayed, and no cuts to provider payments.

If neither one makes it, or if, against all logic, Obama DOES veto it (and he won't) then ICD-10 may still be on track, but be prepared to see provider payments cut by almost 25%.

That said, for me, given my choice, if I have to take a delay or payment cuts...I'll take the delay.

Ideally, we want 2157 to pass. So that is what you want to be pushing your Senators for on your calls...if what you want is on-time implementation AND no payment cuts.
 
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mitchellde said:
I was so afraid of that. We can only hope that with a democratic majority Senate this will not pass. But with this week being spring break in many areas how many of our representatives and senators are even present. This is very bad for our industry. To be saddled with an outdated code set for yet another year when the majority of us have invest valuable time and money into the learning and mastery of this new code set.
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Agreed. We'd been promised that 2014 was THE year and nothing was going to stop it. We've all invested so much money and time into this and now to be told, "just kidding" is horrible.

Also, to tie the ICD-10 delay into a bill that discusses the Medicare SRG reimbursement issue is just wrong.
 
Saedron said:
Agreed. We'd been promised that 2014 was THE year and nothing was going to stop it. We've all invested so much money and time into this and now to be told, "just kidding" is horrible.

Also, to tie the ICD-10 delay into a bill that discusses the Medicare SRG reimbursement issue is just wrong.
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Welcome to the smoky, back-room dealing that is Washington.

As I said above, my own guess as to how this delay in implementation of ICD-10 came to be in the bill:

Some payers were said to possibly not be ready for ICD-10 in time for 2014. This is the kind of bill (SRG reimbursement issue) is one that is likely to actually pass.
It is often a tactic to put onerous items on someone's wish list (items which would never stand on their own) into bills that are all but guaranteed to pass.

My guess is that this delay in ICD-10 implementation was on the wish list of one or more insurance carriers who feared they would not be ready, or who were not going to be ready. These insurance companies likely are campaign contributors. Follow the money from that point.

And I hate to say...collectively, our voice is not likely to have much sway against the power of campaign contributions from entities who wish to delay implementation.

Not supposed to be any quid-pro-quo in our government, of course, but we all either know better or should know better.

At any rate, I suspect this is why S 2157 will not have enough support to pass, and we're gonna get stuck with HB 4302.

Whichever bill DOES get passed, it will go to Obama, and he will sign it. A veto is not going to happen on this bill...whichever one makes it to the President's desk. There is, alas, no way to get the Senate to craft a 4302 bill that removes the delay to ICD-10, thus no way to get a disputed bill into a Conference Committee - which would have been my first and preferred strategy.

At this point, the calls to Senators should indicate support for S 2157 - since that one DOES NOT include the ICD-10 implementation delay. However, if S 2157 is not possible, we should still want HB 4302 to go forward (if neither bill goes to the President...we go over our industry's equivalent of the "fiscal cliff" and our providers will all see payment reductions up to 24 percent from Medicare.)

At this point, there's three possible outcomes...I'll list them in order of my personal preference - and, I believe, the preference of most of us in this industry:

1. Passage of S 2157
Result: No payment cuts to providers and no delay of ICD-10 implementation.

2. Passage of HB 4302 by the Senate (It has passed the House)
Result: No payment cuts to providers. ICD-10 implementation is delayed.

3. Neither bill passes...or Presidential veto
Result: ICD-10 implementation may not be delayed (unless they try to slide that into yet a different bill) - however, this option also carries with it a drastic reduction to provider reimbursements from Medicare - up to 24 percent. Which is a serious income deficit for all affected. It is the equivalent of the fiscal cliff - but only for our industry.

And that is the straight dope.

So call your Senators!! We have till Monday's vote!! Try to push for support for S 2157!!

P.S. Sen. Wyden of Oregon crafted, sponsored, and introduced S 2157, thus he is definitely a supporter. I have Bob Casey of Pennsylvania on record supporting S 2157 and on-time implementation of ICD-10. We need to get the current non-supporters on board.

That said, it would still be good to call Sens. Wyden and Casey, thanking them for supporting S 2157 - and giving them some talking points on why we would support 2157 (what a negative impact a delay of ICD-10 would have on us) - and ask them to speak with their colleagues in the Senate on these talking points, and hopefully try to sway some of their colleagues to support S 2157.

If you're calling Senators other than Wyden or Casey, then it is best to support S 2157 and again, give them the talking points about the negative impact of a delay to implementation of ICD-10.

The problem is this: S 2157 deals with doing away with SRG. It goes WAY beyond the scope of HB 4302.
S 2157 is NOT "just HB 4302 without ICD-10 delay" (which is how many of us here might see it...as this would be the main issue on OUR radar)

S 2157 would get rid of the every-year having to extend SRG (Steny Hoyer in the House voiced support for this approach) But it is far more comprehensive of a "doc fix" and this is a main reason for many non-supporters. It is also why I personally believe we are more likely to get stuck with HB 4302 (small change is easier to make than sweeping change...and 4302 basically keeps the status quo - except, of course, for our purposes...)

The possible outcomes I listed above, in order of most likely to actually happen...are #2, #1, #3.
So we want to try to do what we can to support #1...that is...if what we want is no cuts to providers AND no delay in ICD-10.

Option #3 is only acceptable if you are willing to accept a 24 percent cut in payments - this is why arguing for an Obama veto is not a good idea, in my estimation (and I don't think such a veto would be forthcoming anyway)
 
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The AMA has been pushing for a delay in ICD 10 implementation. That's a pretty big group.

*****************
ICD-10 implementation costs ?much more disruptive?: New study

Posted at 2/12/2014 9:02 AM CST

New estimates of costs to implement the federally mandated ICD-10 code set by Oct. 1 are in some cases nearly three times more than previously estimated, according to a new AMA study.


Costs associated with ICD-10 implementation include training, vendor and software upgrades, testing and payment disruption. Compared to a similar study completed in 2008, these costs could be as much as $8 million for a typical large physician practice. For a small practice, implementation costs could be more than $225,000. The move is expected to be ?much more disruptive for physicians? than previous mandates.





?The markedly higher implementation costs for ICD-10 place a crushing burden on physicians, straining vital resources needed to invest in new health care delivery models and well-developed technology that promotes care coordination with real value to patients,? AMA President Ardis Dee Hoven, MD, said in a news release.


?Continuing to compel physicians to adopt this new coding structure threatens to disrupt innovations by diverting resources away from areas that are expected to help lower costs and improve the quality of care,? Dr. Hoven said.


Current cost estimates are higher now ?due to the need for testing, and the potential for increased payment disruption,? the study reports. ?A major element in cost is clearly the vendor/software upgrade category.?


The study notes specialty practices will see the highest ICD-10 implementation costs, especially in productivity losses and payment disruptions, because of their higher revenues and per hour rates.


The study estimates both pre- and post-ICD-10 implementation costs for average small, medium and large physician practices. While conservative cost estimates fall slightly below 2008 estimates, the range of expenses is much higher than the AMA?s 2008 analysis, and many practices are expected to fall into the higher ranges.


?Because of variability in the size and specialty of practices, there is no ?one size fits all? implementation process for practices to follow,? the study said.


The AMA has been able to keep ICD-10 at bay for more than a decade and continues to urge lawmakers to stop implementation of the code set. Physicians can ask their members of Congress to co-sponsor legislation to stop ICD-10 implementation, known as the Cutting Costly Codes Act of 2013, by sending an email through the AMA?s Physician Grassroots Network.


As the AMA works to halt ICD-10, physicians should continue to prepare for the new code set. Access free educational resources from the AMA for practical insight into the preparation process, or visit the AMA Store for additional training opportunities and products.


These numbers are too important to ignore. Share on social media, and help us #StopICD10.

http://www.ama-assn.org/ama/pub/ama...mmentKey:99d4dca7-a285-4b0e-8bd7-27c225d65183
 
These numbers are too important to ignore. Share on social media, and help us #StopICD10.

http://www.ama-assn.org/ama/pub/ama-...7-27c225d65183
__________________
Renee, CPC
The Best Things in Life Aren't Things

So it is better for us not to have the new coding system which will ultimately have fewer rejections and denials and to be the last country not to have this system because the physicians say it will be to costly?

THAT IS JUST BULL. It is better for the industry. it will make the physicians more money. have less denials. which means less time for billers arguing with insurance companies about why they are not paying. the physicians from what i have seen are the ones that dont want it. the medical billers and coders do. we are the one that do the work to get the money in. getting the codes. sending out the claims correctly. posting the money into the doctors bank account. let the coders and billers be the ones to decide. not the physicians.
 
Well, the argument can be made that we coders and billers are not the ones footing the bill for this implementation (except of course what we spend on our own continuing education...which I could only hope would result in an appreciable ROI)

I, personally am on the fence about this only because many doctors are not documenting the level of specificity demanded by ICD-10. Another year delay may not be a bad thing in order to get the physicians some more training and more into the habit of documenting according to the new standards.

Yes, doctors SHOULD be being very specific in their documentation already...but the ideal world and the real world are two different things, and many doctors that are used to ICD-9 are going to need to develop new habits.

If ICD-10 IS delayed (and I am beginning to think it will be, now that I am aware the AMA is behind the push to delay this) we would do well to use the extra time to get our respective physicians in the habit of better documentation.

As I said in my previous posts, I already had a good idea that the reality appears to be that ICD-10 is going to get delayed...the new information that the AMA is pushing for delay...only serves to confirm for me...the eventual outcome will be delay.

Obviously, the majority view here, and among coders is that we do not want delay...but we should be prepared for that eventuality, and, as I said, use the extra time to develop better documentation habits in the physicians we serve.
 
The reason the providers are against ICD-10 is mainly due to the EMR. The EMR forces the provider to supply the codes befor the record can be signed out. Why have they never fought a change in the code set before? From ICD-8 to ICD-9, there was no fuss or discussion. Because the provider never had to use the numeric codes. We need to retool this industry and go back to a earlier version. It is best if the provider does not assign the code. It is best if they do not use templets for documentation. If the provider never had to worry about learning the codes and code assignment then they would not care which code set is in play. Then all they would need is knowledgeable coding staff.
 
here is the latest. Notice they stipulate that come monday, there will be no amendments to the bill and it will be a roll call vote. Basically it looks like they have agreed to pass this as a last act on Monday and send it to the President , they need this to pass befor midnight to meet the April 1 deadline. So do you really think the president will veto this??

The Senate has reached an agreement to vote on passage of the SGR bill on Monday, March 31, with a 60-affirmative vote point of order. We expect a Republican to raise a Budget point of order against the bill prior to the vote on passage.



As a result of this agreement beginning at 5:30pm on Monday, March 31, there would be 3 roll call votes and 1 voice vote. Those would be on the following:



- Confirmation of Executive Calendar #573, John B. Owens, of CA, to be US Circuit Judge for the Ninth Circuit (majority vote threshold);

- Motion to waive applicable budget points of order with respect to H.R.4302, Protecting Access to Medicare Act of 2014 (SGR/Doc Fix) (60-vote threshold);

- Passage of H.R.4302, Protecting Access to Medicare Act of 2014 (SGR/Doc Fix) (60-vote threshold); and

- Adoption of the motion to proceed to H.R.3979, the legislative vehicle for the Unemployment Insurance extension (voice vote expected)



The agreement is as follows:



Following Leader remarks on Monday, March 31st, the Senate proceed to the consideration of H.R.4302, which was received from the House and is at the desk; that there be no amendments or motions in order to the bill with the exception of budget points of order and the applicable motions to waive; that the time until 5pm be equally divided between the two Leaders, or their designees, for debate on the bill; that notwithstanding the previous order, following the vote on confirmation of the Owens nomination on Monday, March 31st, the Senate resume consideration of H.R.4302, the bill be read a third time and the Senate proceed to vote on passage of the bill; that the bill be subject to a 60 affirmative vote threshold; finally, that upon disposition of H.R.4302, the Senate proceed to vote on the motion to proceed to H.R.3979, as provided under the previous order.
 
ABridgman said:
Yes, doctors SHOULD be being very specific in their documentation already...but the ideal world and the real world are two different things, and many doctors that are used to ICD-9 are going to need to develop new habits.

Obviously, the majority view here, and among coders is that we do not want delay...but we should be prepared for that eventuality, and, as I said, use the extra time to develop better documentation habits in the physicians we serve.
Click to expand...

I have 48 providers; about 1/3 of them simply will NOT document specifically now because ICD9 does not encourage it. (See 729.5) My ever present thorn in the side is diabetic manifestations.... 250.60 is not diabetic peripheral neuropathy, Dr.!
I believe that ICD10 actually will help providers in their selection of specific codes; we just won't have that benefit for 18 MORE months at least :mad:
 
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