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ICD-10 code claims implementation until October 2015 –Implications?

June 5, 2014

ICD-10 implementationUS legislature has extended the ICD-10 medical billing code claims implementation until October 2015 – What are the implications?

Senate vote delaying the implementation of ICD-10-CM/PCS by at least one year was passed 64-35 on Monday, March 31. Seven lines of bill H.R. 4302 are about Medicare payments to physicians. They state that Health and Human Services cannot initiate the ICD–10 standard until October 1, 2015 or later. Thousands of AHIMA members opposed the ICD-10 implementation delay. Believing that the transition is inevitable and time sensitive, AHIMA highlighted the risks of delay, citing the need to provide the most effective tracking and analysis of clinical services and treatments. In essence, postponement is at odds with the delivery of effective patient care.

A significant number of educational programs have been teaching ICD-10 coding and procedures in preparation for the 2015 deadline. Healthcare organizations nationwide have already begun preparation for ICD-10, with major expenditures devoted to staff training and computer system enhancements or replacement.

The Coalition for ICD-10, with a member body including the American Medical Informatics Association, BlueCross, the College of Healthcare Information Management executives, Siemens Health Services and 3M Health Information Systems, urged that the ICD-10 deadline remain as October 2015.

While some say that patient care organizations that have been in the process of preparing for ICD-10 have wasted their time and resources, this is not the case. This upgrade is inevitable and has only been postponed for a year. The extension can be viewed as a deadline that has been moved forward, offering practices the ability to extend their familiarity with the code set, and hone their procedural, workflow and system testing. Neither resources nor time have been wasted.

During this extended period, those who aren’t prepared have the opportunity to become prepared—preparation that should be supported by large organizations with the expertise to advise practitioners, including the federal government. Aetna’s reaction to this delay is:

“We will continue working on our ICD-10 projects to ensure that our systems, vendor tools, and business processes and policies will be ready for the new compliance date. We’ll follow guidance from the Department of Health and Human Services and Centers for Medicare & Medicaid Services. We will work closely with the medical community to monitor compliance and manage risk.”

Here is some advice for 2015 compliance:

  • Contact billing and software vendors to obtain and discuss their ICD-10 conversion and test plans
  • Scrutinize clinical, financial, billing and coding processes to identify the impact of conversion to ICD-10 on your organization
  • Obtain ICD-9 to ICD-10 mapping guides and templates. CMS provides General Equivalency Mappings for converting ICD-9 codes to ICD-10 codes.
  • Continue to follow the direction of regulatory authorities, and adapt your implementation strategy as needed.
  • Sign up for CMS ICD-10 Industry Email Updates and follow CMS on Twitter to stay abreast of changes.
  • Robust testing is essential to success. Waiting until the deadline invites failure. Providers must test their billing systems with clearing houses and payers to validate and refine practice procedures and diagnosis combinations six months before going live.
  • Access tools that provide reimbursement trend alerts and enable providers to locate bottlenecks. The insight they offer will help eliminate inefficiencies and foster a successful transition.
  • Communicate – daily team meetings with those involved in claims processing or ICD-10 coding can help identify issues and solve problems as they arise. These meetings should take place both before and after ICD-10 compliance begins and can help iron out transition difficulties.

The delay in ICD-10 implementation was the result of combining a Medicare MD Payment Bill with ICD-10 implementation. It was passed in a very hurried way with little preparation time offered to legislators. ICD-10 is not a convenience; it’s a proven, sophisticated code set used internationally to track and analyze health and treatment patterns. Adoption of this ICD-10 is essential to implementing effective modern medicine. A commitment by all players to meet the 2015 deadline is required.

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