CMS: Delay Necessary, But ICD-10 Will Happen

On the same day that a proposed delay for ICD-10 compliance officially hit the books, the Centers for Medicare and Medicaid Services (CMS) reiterated Tuesday they are committed to eventually implementing ICD-10.

Giving a “State of the Union” on ICD-10 at Tuesday’s ICD-10 Summit in Baltimore, CMS acting deputy director of the Office of E-Health Standards and Services, Denise Buenning, MsM, explained why a delay and official implementation of the code set is essential for the healthcare industry.

“To borrow a line from our president, the state of ICD-10 at CMS is strong and our commitment to its implementation is strong and focused,” Buenning said.

Buenning helped author the original final rule requiring ICD-10 on October 1, 2013, as well as the proposed rule published Tuesday in the Federal Register that would delay implementation until October 1, 2014.

“AHIMA has been a staunch proponent of the 2013 deadline,” she noted, before describing CMS’ reasoning for the delay announced February 15. “The industry has expressed shock, surprise, and wonder as to why the decision was made.”

Reasons Behind the Delay
It was no one group that spurred CMS to propose the delay, but a series of events, Buenning said, that made a delay inevitable. The primary reason was the industry’s ongoing struggle to implement HIPAA Version 5010, a precursor to ICD-10 that was effective January 2012 but has seen enforcement delayed twice because many physicians have had technical trouble implementing the version update. CMS saw the Version 5010 issues, which some providers said prevented them from getting paid, as a signal that ICD-10 efforts would face a similar fate unless a delay was enacted.

“If this was the 5010 implementation, which was supposed to be the easy one, what would be the exponential impact on ICD-10?  Five million claims per week were in jeopardy,” Buenning said.

Other factors that convinced CMS that a delay was necessary included physician outcry regarding the ICD-10 timeline and studies that Buenning said showed other industry sectors would not meet the 2013 deadline.

AHIMA has officially recommended that the 2013 implementation deadline remain, saying a majority of the healthcare industry is on track to meet the deadline and that those who worked hard to meet the original deadline shouldn’t be punished with the additional costs that will come with a delay.

CMS was presented with “many unsolicited comments regarding the delay” and its timeline, Buenning reported, which ranged from no delay, to delay two years, to skipping ICD-10 and moving directly to ICD-11. The decision to propose a one-year delay was made after hearing from the industry that delaying beyond a year would “kill ICD-10 (efforts) and punish early implementers.”

The one-year delay reflects the industry’s need for a quick resolution and providers’ need for additional time to implement, and it likely won’t penalize those on track with the original deadline, she said.

While proposed rules typically receive a 60-day comment period, the ICD-10 delay rule was given a 30-day period in order to speed the delivery of a final rule. The healthcare industry is waiting for a solid deadline before it can redesign implementation plans accordingly.

Buenning encouraged everyone to submit comments and provide their feedback on the proposed rule. A one-year delay is “not a slam dunk,” and CMS will be listening to industry feedback.

“We read every comment, slice and dice them, and ensure all elements are included in the final rule,” she said. “[AHIMA] is a respected voice,” she told the gathered crowd. “Now more than ever, it is time for proponents of ICD-10 to make their voice loud and clear.”

Stay the Course
Despite the delay, ICD-10 will be implemented, Buenning assured the audience.

“Regardless of the delay time, the worst thing you can do is to stop ICD-10 implementation,” she said. “Follow our lead and stay the course.”

The industry should use the extra time to get on track with compliance and test their systems to ensure a repeat of Version 5010 is prevented.

As Buenning stated that CMS has been committed to ICD-10 in the past, and will continue into the future, a timeline was shown, tracing CMS’ ICD-10 efforts back to 1990.

While she couldn’t comment specifically on other government programs, Buenning did say that developers of programs tied to ICD-10, like the meaningful use program and quality measure developers, are staying in the loop with the delay and would keep it in mind with their work.

HHS will not reimburse the industry for costs predicated on the October 1, 2013, date—one frequently asked question Buenning answered. However, CMS does understand the burden a delay places on entities like academic programs that need to redefine their curriculum, and students who may need to seek additional ICD-9 or ICD-10 training in light of the delay, she said.

“ICD-10 is an unfunded mandate…” she said. “Patient care must trump all.”

Take a Leadership Role
Not all providers are for a delay, a point made by Dr. Jeff Linzer, with the American Academy of Pediatrics, during the audience question and answer session. He told the crowd his organization will publish against any delay, saying physicians have had adequate time to prepare for ICD-10 and that the code set, largely created by physicians, can only improve care.

The contention from some providers that ICD-10 has no return on investment or clinical benefit is “false and foolhardy,” Buenning said, and CMS has been actively educating the industry about ICD-10’s impact and potential benefits.

HIM professionals are the “front lines” of outreach and education for providers, and Buenning encouraged the crowd to take a leadership role in ICD-10.

“Don’t lose momentum; use the extra time, it is a gift to get this right,” she said. “ICD-10 is going to happen.”


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