The document discusses the delay of ICD-10 implementation from its original date to October 1, 2015, amid changes in Medicare payment structures. It outlines the historical context of ICD classifications, the advantages and disadvantages of the delay, and the responses from various vendors. The delay is seen as a temporary relief for financial pressures on providers but raises concerns about longer-term impacts on healthcare documentation and coding practices.

1. ICD-­‐10
Delay
Wednesday,
January
29,
2014
Disclaimer:
Nothing
that
we
are
sharing
is
intended
as
legally
binding
or
prescrip7ve
advice.
This
presenta7on
is
a
synthesis
of
publically
available
informa7on
and
best
prac7ces.

2. • 1893
-­‐
Ber7llon
Classifica7on
of
Causes
of
Death
• 1900
-­‐
Interna7onal
Classifica7on
of
Causes
of
Death
•
Version
6
Interna7onal
Sta7s7cal
Classifica7on
of
Diseases,
Injuries
and
Causes
of
Death
• 1948
-­‐
The
World
Health
Organiza7on
assumed
responsibility
to
maintain
• 1975
-­‐
adopted
the
3
character
classifica7on
to
maintain
some
consistency
-­‐
Interna1onal
Classifica1on
of
Diseases
• Many
modifiers
and
adapta7ons
along
the
way
• 1992
-­‐
ICD-­‐10
was
published
• 2017
-­‐
ICD-­‐11
will
be
published
ICD
History

3. • The
ICD-­‐10
code
sets
are
NOT
simply
increased
and
renumbered
ICD-­‐9
code
sets.
• The
ICD-­‐10
code
sets
include
greater
detail,
changes
in
terminology,
and
expanded
concepts
for
injuries,
laterality,
and
other
related
factors.
• The
complexity
of
ICD-­‐10
provides
many
benefits
because
of
the
increased
level
of
detail
conveyed
in
the
codes
–
American
Medical
Associa1on
What
is
ICD-­‐10

4. How
ICD-­‐10
Differs
from
ICD-­‐9

5. • Protec1ng
Access
to
Medicare
Act
(H.R.
4302)
• “DOC
FIX”
-­‐
The
Sustainable
Growth
Rate
(SGR)
was
set
to
reduce
Medicare
physician
payment
rates
by
24%
on
April
1,
2014.
• SGR
was
set
by
the
Centers
for
Medicare
and
Medicaid
Services
(CMS)
to
control
Medicare
spending
on
physician
services.
• Congress
introduced
"doc
fix"
included
a
provision
to
delay
the
ICD-­‐10
compliance
date
to
October
1,
2015.
• The
House
passed
the
bill
to
postpone
the
SGR
and
delay
ICD-­‐10
on
Thursday,
March
28,
2014,
and
the
Senate
passed
the
same
bill
on
Monday,
March
31,
2014.
The
ICD-­‐10
Delay

6. What
does
this
mean....
The
Good:
• Our
clients
don't
need
to
undertake
the
financial
hit
of
ICD10
while
also
absorbing
the
reduced
Medicare
fee
schedule
and
the
Affordable
Care
Act
(which
is
leading
to
higher
pa1ent
pays
and
Medicaid
enrollment).
The
Bad:
• Everyone
must
s1ll
upgrade
this
year
on
all
EHRs.
The
2011
cer1fica1ons
expired
on
12/31/13
and
new
2014
cer1fied
systems
are
needed
for
both
MU1
and
MU2.
Clinics
should
be
looking
to
upgrade
now
and
ahest
no
later
than
Q3
(or
look
into
the
new
hardship
exemp1ons).
To
sum
it
up:
• ICD-­‐10
delay
at
this
point
is
a
good
tac1c,
but
part
of
a
bad
strategy.
If
we
are
going
to
change
the
en1re
landscape
of
healthcare,
let’s
do
the
sensible
thing
and
spread
it
out
over
a
period
of
years,
not
a
period
of
months.
-­‐Ben
Quirk
Quirk
Response

7. • Retes1ng
• Training
and
implementa1on
already
set
up
• Shortcuts
that
prevented
more
thoughkul
changes
in
order
to
meet
the
deadline
• Students
in
medical
coding
currently
enrolled
are
preparing
for
ICD-­‐10
and
some
do
not
have
ICD-­‐9
exposure
• Budgeted
expenses
already
allocated
for
execu1on
• May
slow
sales
• May
delay
upgrades
• The
reduc1on
of
24%
in
payments
will
increase
if
a
permanent
fix
is
not
implemented
• Many
vendors
have
acted
in
good
faith
and
invested
significant
1me,
energy,
and
resources
to
comply
with
the
deadline.
CMS
es1mates
that
a
one-­‐
year
delay
of
ICD-­‐10
could
cost
between
$1
billion
and
$6.6
billion
Nega1ve
Cri1cism
of
the
Delay

8. • Avoiding
Cash
Flow
disrup1on…for
now
• The
Centers
for
Medicare
and
Medicaid
Services
(CMS)
es1mates
that
in
early
stages
of
implementa1on,
denial
rates
will
rise
by
100
to
200
percent,
and
that
days
in
accounts
receivable
will
grow
20
to
40
percent.
• Migra1on
to
ICD-­‐10
carries
a
risk
due
to
incomplete
or
inaccurate
transla1on
of
exis1ng
policies,
benefits,
and
payment
rules
within
payer
systems.
• Delays
in
payments
can
also
occur
because
of
challenges
in
claim
processing
in
the
ICD-­‐10
environment.
• Programmers
look
at
it
as
a
“longer
runway”
or
1me
to
“get
it
right”
• Others
feel
it
is
a
good
1me
to
focus
on
MU2
and
ACO
programs
• Physicians
avoiding
up
to
a
24%
reduc1on
in
re-­‐imbursement
rates
• Allocated
funds
can
be
invested
as
reserves
and
earn
interest
Posi1ve
Cri1cism
of
the
Delay

9. • Increased
focus
on
clinical
documenta=on
improvement
(CDI).
s1ll
a
cri1cal
component
to
quality
repor1ng
and
improving
cash
flow.
• Develop
long-­‐term
coder
strategy.
Regardless
of
a
delay
decision,
you
will
need
a
strategy
to
retain
and
incen1vize
coders
• Op=mize
your
revenue
cycle
performance.
The
delay
provides
an
opportunity
to
perform
a
“deep
dive”
that
will
explore
and
improve
exis1ng
• Evaluate
Computer
Assisted
Coding
(CAC).
You
can
use
the
delay
to
do
a
search
and
selec1on
and
evaluate
how
a
CAC
op1on
can
help
achieve
transi1on
goals
while
reducing
costs
and
increasing
coder
produc1vity.
• Con=nue
dual
coding
and
training.
The
delay
will
provide
you
with
more
1me
to
iden1fy
poten1al
risk
areas/issues
between
ICD-­‐9
and
ICD-­‐10
codes
• Comprehensive
system
remedia=on
&
tes=ng.
You
now
have
1me
for
a
more
comprehensive
plan
to
ensure
all
IT
systems
and
partners
are
capable
of
receiving
and
producing
ICD-­‐10
codes
for
billing
and
internal/external
repor1ng
purposes.
•
Focus
on
physician
educa=on
(employed
and
ancillary).
It’s
important
that
you
con1nue
as
planned
with
CDI
training
for
physicians.
The
addi1onal
training
will
allow
the
physicians
more
1me
to
both
learn
and
adopt
the
increased
documenta1on
requirements.
-­‐Beacon
Partners
Posi1ve
Cri1cism
of
the
Delay

10. What
the
vendors
are
saying…
Prac1ce
Fusion
• As
a
result
of
this
one
year
delay,
Prac1ce
Fusion
providers
will
not
be
required
to
use
ICD-­‐10
codes
in
healthcare
claims
this
year.
However,
ICD-­‐10
is
s1ll
coming,
so
it’s
important
for
all
stakeholders
in
the
healthcare
industry
to
become
familiar
with
ICD-­‐10.
• Prac1ce
Fusion
was
prepared
to
help
providers
customers
to
meet
the
2014
deadline,
and
despite
the
delay,
we
will
con1nue
to
help
our
providers
prepare
well
in
advance
of
October
1,
2015.
Keep
on
the
lookout
for
more
blog
posts,
webinars,
in-­‐product
tools,
and
other
educa1onal
resources
to
help
with
the
ICD-­‐10
transi1on.
-­‐Ryan
Donovan
|
VP
Corporate
Communica1ons

11. What
the
vendors
are
saying…
Allscripts
• The
ICD-­‐10
delay
does
not
change
Allscripts
plans.
We’ve
informed
our
clients
that
everything
is
s1ll
on
schedule
and
have
encouraged
them
to
upgrade
as
they
originally
planned
to
ensure
they’re
prepared.
-­‐Ariana
Nikitas
|
Director
of
Client
Communica1ons
-­‐Russ
Cobb
|
VP
of
Marke1ng
and
Communica1ons
For
the
full
statement,
please
visit:
h4p://www.allscripts.com/en/resources.html

12. What
the
vendors
are
saying…
Greenway
All
I
know
is
that
we
are
in
full
deployment
mode
and
nothing
has
changed
on
our
side.
We
encourage
clients
to
focus
on
exis1ng
programs
that
create
a
strong
founda1on
for
evolving
and
future
value-­‐based
and
alterna1ve
payment
incen1ve
models,
such
as
accountable
care
organiza1ons
(ACOs)
and
pa1ent-­‐centered
medical
homes
(PCMHs).
-­‐Jus1n
Barnes
|
VP
of
Government
Affairs

13. What
the
vendors
are
saying…
Athenahealth
Guaranteed
success
with
or
without
the
delay
or
your
money
back.
They
feel
like
there
are
no
impacts
to
their
system.
“It
is
unfortunate
that
the
government
has
once
again
chosen
to
delay
ICD-­‐10.
athenahealth
and
its
clients
are/were
prepared
for
the
ICD-­‐10
transi1on,
and
in
fact
we
have
na1onal
payer
data
showing
that
78
percent
of
payers
are
currently
proving
readiness
in
line
with
the
2014
deadline.”
-­‐Ed
Parks|COO
For
the
full
statement,
please
visit:
h4p://www.athenahealth.com/blog/
2014/03/31/icd-­‐10-­‐dismay/