Practice Management Institute (PMI) Today Announced Intent to Continue ICD-10 Instruction Despite a Motion Passed Late Yesterday to Delay ICD-10

Practice Management Institute (PMI) today announced intent to continue ICD-10 instruction despite a motion passed late yesterday to delay ICD-10 implementation until October 1, 2015.

Practice Management Institute (PMI) today announced intent to continue ICD-10 instruction despite a motion passed late yesterday to delay ICD-10 implementation until October 1, 2015. The passage of H.R. 4302 also averts a 24 percent payment reduction in provider reimbursement for Medicare services for the next 12 months. The bill now awaits the President's signature.

The bill would allow Congress to pass again on a permanent fix to the Sustainable Growth Rate (SGR), a formula which determines the rate of compensation providers receive for procedures paid by Medicare. Long criticized as a flawed payment system, Senator Orrin Hatch (R-Utah), said yesterday that while bipartisan talks had arrived at a solution, there was no agreement reached for how to pay for the SGR fix.

Just last week, the health care community discovered an important and little-known provision tucked into the bill that would delay ICD-10 implementation until October 2015, despite decries from the Centers for Medicare and Medicaid Services (CMS) that there would be no further delays.

While the passage of this bill opens up an additional 12-month preparation window, it disregards the work that so many organizations have already done to prepare for the transition that was to take place in 26 weeks. Organizations such as the American Medical Association (AMA) and the American Hospital Association (AHA) who have spoken out against the passage have said that the decision promotes further distrust in Congressional action among the health care community.

ICD-10 implementation is an important step in the process of evolving payment models, according to the National Commission of Physician Payment Reform, a group formed to eliminate the fee-for-service payment model in order to rein in skyrocketing health care costs. The National Committee on Vital and Health Statistics (NCVHS) similarly stated in a letter to Congress this past week, "By allowing for greater coding accuracy and specificity, ICD-10 is key to collecting the information needed to implement health care delivery innovations such as patient-centered medical homes and value-based purchasing."

ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by Health Insurance Portability Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims. The transition addresses the need for new and expanded codes not possible in the outdated ICD-9 version.

"Practice Management Institute, along with leading health care entities and coalitions recognize the importance of recording more specific information in the medical record to substantiate the need for services rendered, quality of care, and improvements in coding accuracy to achieve fair reimbursement for physicians and other providers of health care," said Maxine Collins, PMI Faculty/Consultant. "We will continue efforts to prepare providers for the conversion."

Collins says that the move to ICD-10 is inevitable if this country wants to improve reimbursement models and get to the next level of care based on quality rather than quantity.

"We have made advances in the last several months in educating providers concerning the role that more specific information plays in reducing coding and billing errors which, in turn, results in higher reimbursement," said Collins.

The delay will ease the burden on physicians who have been fighting the clock to get implementation efforts in the practice. Even with 18 months rather than six to prepare, some offices may still lag behind the initial 20-month preparation window recommended by the Centers for Medicare and Medicaid Services (CMS) in its ICD-10 Timeline for Small-Medium Practices.

"PMI has been teaching ICD-10 almost exclusively over the past several months in order to meet the increase in demand," said PMI's President and CEO, David T. Womack. "When we asked rooms full of participants how prepared they are for ICD-10, they would tell us, 'I bought the book.' And, while the extension offers a much needed breather, now is not the time to tap the brakes; training is as important as ever."

Planning and communications strategy areas should be undertaken now. Physicians should learn how the new coding characteristics will require higher degree of documentation specificity. Dollars should be earmarked for future conversion expenses. Coders should increase their level of knowledge of expanded anatomy and physiology, medical terminology and familiarity with the new coding format.

ICD-10, which is already in use by a majority of countries across the globe, would provide for the increased level of detail needed to support newer payment models and payment based on health outcomes rather than by volume.


Categories: Hospitals and Clinics

Tags: HR 4302, ICD-10, Medicare, Physician Reimbursement, PMI, practice management institute, provider, SGR

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