Health Information Management

ICD-10 implementation date now up in the air

APCs Insider, March 28, 2014

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A single sentence added to a House of Representatives bill that went unremarked-upon during a brief pre-vote debate could have major repercussions for the healthcare industry. 

In a controversial voice vote, which did not require a roll call of each member's vote, the House passed H.R. 4302 Thursday. While the focus of the bill was to repeal a mandatory 24% cut to physician Medicare payments slated to begin April 1, it also prohibits the Secretary of Health and Human Services from implementing ICD-10 before October 1, 2015.
The bill now goes to the Senate, where it is expected to be voted on Friday. Most of the opposition to the bill is centered on the fact it is not a permanent SGR fix, but the likelihood of Congress finding the permanent fix it has sought for 10 years, by Monday, is low.
It's unclear who inserted this clause, or why. AHIMA, along with other industry partners, strongly opposed the delay, arguing that it could cost the industry anywhere from $1 billion to $6.6 billion. Even the AMA, which has been an ardent supporter of delaying ICD-10, opposed the bill, since the group supports a permanent fix for the SGR, not the annual fixes that Congress has applied.
No clear winners emerge in this scenario. Congress has completely undermined CMS, which has repeatedly stated ICD-10 implementation would not be delayed again. CMS even appeased the AMA by reversing its stance on end-to-end testing, now planned for July.
Any update from CMS will now be met with skepticism. Even if providers choose to believe CMS on whatever new implementation date is set, the whims of Congress could make it meaningless.
Providers would get more time to prepare if the delay occurs, but what about all those who have been dual coding with ICD-9 and ICD-10, increasing staffing levels, and upgrading technology? They'll have to make big decisions on what to do with those resources as they await word on a new implementation date.
An important part of the law's wording is that ICD-10 cannot be implemented "prior" to October 1, 2015. This does not mean it will automatically be implemented on that date. If the Senate bill includes the same language, expect a brand new argument on whether the industry should even make the switch to ICD-10, with the completion of ICD-11 expected in 2017. 
Considering the U.S. is still not fully prepared for ICD-10 more than 20 years after it was completed, any argument to wait for ICD-11 would be another effort to delay a problem instead of facing it head on—just like the industry is accusing Congress of doing with the SGR.
Do you support the delay of ICD-10? Let us know by voting in the poll below.
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