Health Information Management

Associate Director's Note: Another step toward ICD-10 in 2015?

CDI Strategies, April 2, 2015

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Last week the House of Representatives passed a bill to replace the Sustainable Growth Rate (SGR; a budget cap passed into law in 1997 to control physician spending) before Congress recessed for a two-week spring break.

The Senate didn’t.p>

That means no law.

That means no “doc fix.”

That means proponents for ICD-10-CM/PCS’ 2015 implementation must continue to worry that their elected officials might try—once again—to sneak delay language into forthcoming SGR legislation when Congress returns. After all, that’s what they did last March 31 at the 11th hour.

The AMA says it is “extremely disappointed” that the Senate did not vote on the Medicare and CHIP Reauthorization Act (the bill which included SGR appeal language).

Those supporting the October 1, 2015 implementation date continue to express optimism. In a Coding Clinic webinar last week, Nelly Leon-Chisen, RHIA, director of coding and classification for AHA in Chicago told listeners that she doesn’t expect another delay. AHIMA continues its grassroots political campaign via social media. And ACDIS encourages its members to continue to prepare for ICD-10 by obtaining detailed medical record documentation now.

Should the implementation date remain unchanged, the “six-months-to-implementation” mark will have passed as of April 1. The industry will have passed the point in the marathon where the finish line looms, where the runner calls on energy reserves, and kicks into high gear. Those waiting for the definitive government approval of ICD-10-CM/PCS implementation who are still loping along the route may lose the race for their facilities. 

While the ICD-10-CM/PCS implementation news (or rather non-news) represented the most important piece of the SGR tale for most CDI and HIM professionals, let’s not forget what the delay means for physicians—a potential 20% reduction in their Medicare reimbursement. Should Congress reconvene in two weeks and pass a fix as soon as possible, it might prevent such a devastating outcome.

If the Senate approves a bill as proposed by the House, the new law would repeal the SGR replacing it with annual increases of 0.5% over the next five years. The proposal provides 5% bonus incentives to physicians who receive a significant portion of their revenue from an alternative payment model, shifts the focus from fee-for-service to quality and value payment methods, and increases the focus on, and use of, Medicare data and use on the Physician Compare website. All these buzz words that CDI has been hearing and touting for years on the hospital side will now also directly affect physician payments.

If that’s not enough to raise a CDI eyebrow or two, the Protecting the Integrity of Medicare Act of 2015 was appended to the SGR repeal bill. It includes language which would require Medicare Administrative Contractors to set up outreach programs to provide education regarding improper payments and to keep providers informed about their “most frequent and expensive payment errors”—errors that frequently arise due to lack of proper medical record documentation.

Every good race includes its share of drama, and the SGR debate does too. Regardless of the ultimate outcome, the message for CDI staff and programs remains clear—documentation improvement matters throughout the race as well as at the finish line.

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