Jul 24, 2012 (09:07 AM EDT)
ICD-10 Deadline Uncertainty Breeds Healthcare Procrastination

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The Great ICD-10 Debate: Healthcare Coding Transforms
The Great ICD-10 Debate: Healthcare Coding Transforms
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The American Hospital Association (AHA) would like the Centers for Medicare and Medicaid Services (CMS) to, as quickly as possible, issue a final rule that includes a firm deadline for ICD-10 implementation so that providers will have enough time to be ready by that date, AHA officials told InformationWeek Healthcare. The Department of Health and Human Services (HHS), which includes CMS, proposed in April that the deadline for shifting to the new diagnostic code set be postponed for one year, from Oct. 1, 2013, to Oct. 1, 2014.

Because of the uncertainty about the deadline, hospitals' focus on ICD-10 is starting to waver, said Chantal Worzala, director of policy for AHA. "We are in an environment where the demands on providers are really great," she said. "So there is a natural tendency to prioritize among all the things you have in front of you. We asked CMS to finalize its rule as quickly as possible so we can go back to a state of certainty about the date."

AHA wants CMS to set the Oct. 1, 2014 deadline in stone--rather than putting it off further--because many hospitals have already invested considerable time and effort in preparation for the original 2013 start date. The American Medical Association (AMA), in contrast, has asked CMS for a two-year extension of the deadline, which AHA considers too long a delay. "There would be an additional cost to carry it beyond [2014]," explained George Arges, senior director of AHA's health data management group.

Meanwhile, payers also have a distance to travel before they're ready for ICD-10. In a recent survey by HealthEdge, an insurance software vendor, just 61% of health plans said they would "definitely" be ready to accept ICD-10 claims by Oct. 1, 2014. Another 30% said they'd "likely" be prepared by that date.

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Arges expressed confidence that, once CMS sets a firm deadline, most health plans and providers will work hard to meet it, "After the rule is finalized, the whole healthcare field--payers, physicians, hospitals--will all ramp up their ICD-10 efforts and move ahead," he said.

It's unclear how many payers might not be prepared by Oct. 1, 2014. Certainly, as Worzala suggested, a final rule would accelerate the efforts of health plans to comply with the regulations. But some plans have heavy lifting to do. In the HealthEdge survey, 39% of the respondents said their claims processing systems were more than 15 years old, and 41% said they were not planning to augment or replace their systems in the next two years.

Will the threat of federal sanctions force all plans to meet the ICD-10 deadline? Not likely, said Robert Tennant, senior policy advisor for the Medical Group Management Association (MGMA), in an interview. No health plans have been financially penalized for non-compliance with the HIPAA 5010 administrative transaction set, he noted. And, if CMS required corrective action plans from insurers that didn't switch to ICD-10 on time, that wouldn't help providers who weren't getting paid.

"The reality is that some plans are not going to be ready," he said, adding that that's only part of the problem. The other part is that the insurers need to be prepared to test the submission of ICD-10 claims with providers well before the deadline.

As of last March, most health plans did not intend to do external testing until 2013, and a minority of them had completed their internal assessments, according to a survey by the Workgroup for Electronic Data Interchange (WEDI).

Arges pointed out that providers have yet to define their ICD-10 testing criteria with payers--another reason why AHA wants the government to release its final regulations soon. "We'd like our members to have time to define their external testing and discuss it with the health plans."

The overarching goal for AHA, Worzala emphasized, is to get providers back on track to complete their ICD-10 work. "When CMS puts out a final rule and everybody starts to say ok, 'this is the date,' and they get back to the work of preparing, we can take that extra time and use it to ramp up the testing with our trading partners, including the insurers," she said.

CMS had no comment at press time.

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