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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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AMA Urges CMS to Provide Backup Plans for ICD-10 Transition

AMA Urges CMS to Provide Backup Plans for ICD-10 Transition | EHR and Health IT Consulting |

What would happen to a medical practice that has one in five of its Medicare claims not properly processed by the Centers for Medicare & Medicaid Services (CMS)? It could lead to a serious financial disruption and strain the budgets of most medical facilities. However, this is just the scenario that could occur on Oct. 1, 2015 when the country carries out the ICD-10 transition if CMS does not develop suitable contingency plans.

The American Medical Association (AMA) and 99 other specialty groups from around the country called for CMS to develop contingency plans for the anticipated failures once the nation transitions to the ICD-10 code set, according to an AMA press release.

The impact to the healthcare sector upon ICD-10 implementation could be severe, leading to a multi-billion dollar disruption and significant access to care problems for Medicare patients. The latest end-to-end testing results show that the Medicare claims acceptance rate would decline from 97 percent to just above 80 percent if ICD-10 implementation occurred today.

Even this percentage on its own could lead to an accumulation of millions of unpaid Medicare claims, which would severely damage the financial outlook of the healthcare industry. However, since the end-to-end ICD-10 testing only speaks for about 1 percent of all Medicare providers, the acceptance rate in actuality may be lower, depending upon how prepared the country is for the ICD-10 transition by October 1.

“The likelihood that Medicare will reject nearly one in five of the millions of claims that go through our complex health care system each day represents an intolerable and unnecessary disruption to physician practices,” AMA President Robert M. Wah, M.D., said in a public statement. “Robust contingency plans must be ready on day one of the ICD-10 switchover to save precious health care dollars and reduce unnecessary administrative tasks that take valuable time and resources away from patient care.”

Along with creating contingency plans, the AMA and other groups are asking CMS to consider how the ICD-10 transition will impact the Physician Quality Reporting System (PQRS) and meaningful use requirements.

The reporting periods for both meaningful use and PQRS will take place more than three-quarters into the calendar year, which means the 2015 reporting data will use both ICD-9 and ICD-10 codes. This will be especially confusing for providers that are treating patients for the same condition right before and right after the October 1 deadline.

The AMA President Dr. Wah continued by explaining that the federal government may be “underestimating the impact” of ICD-10 implementation on providers that are already being encumbered by the many healthcare regulations currently in place. The AMA is focused on reducing burden on physicians and ensuring enough information is given regarding the effects of the ICD-10 transition. A major goal of the AMA is to confirm physicians are able to avoid Medicare payment penalties.

A total of 100 physician groups are asking CMS to provide contingency plans for the anticipated issues of the ICD-10 transition. Having plans in place can help avoid the potential backlog of millions of unpaid Medicare claims once ICD-10 implementation occurs.

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Hospital Groups Call for Avoiding Another ICD-10 Delay |

Hospital Groups Call for Avoiding Another ICD-10 Delay | | EHR and Health IT Consulting |
Hospital groups have written a letter to leaders of Congress asking the latter to avoid another ICD-10 delay.

With less than ten months to go before healthcare organizations and providers need to comply with most recent ICD-10 transition deadline, the standoff between proponents and opponents of the 2015 ICD-10 compliance date is increasing in intensity.

A band of hospital and health system associations have written a letter to leaders of Congress asking the latter to avoid another ICD-10 delay. A total of eight industry groups have undersigned the petition:

“As the organizations representing more than 5,000 hospitals and health systems across the country, we strongly support the announced October 1, 2015 ICD-10 compliance date and oppose any steps to delay,” the organizations write. “Recent ICD-10 implementation delays have been disruptive and costly for hospitals and health systems, as well as to health care delivery innovation, payment reform, public health, and health care payment.”

The letter to Representatives John Boehner (R-OH) and Nancy Pelosi (D-CA) and Senators Harry Reid (D-NV) and Mitch McConnell (R-KY) specifically recalls the setbacks resulting from the most recent one-year delay of ICD-10 implementation from 2014 to 2015:

The delay added billions of dollars in extra costs. Many of our members had to quickly reconfigure systems and processes that were prepared to use ICD-10 back to ICD-9. Newly trained coders who graduated from ICD-10 focused programs were unprepared for use of the older code set and needed to be retrained back to using ICD-9. Further, training of existing coders needed to be repeated given the one-year delay. This results in a doubling of costs that are not productive. A further delay would only add additional costs as existing investments would be further wasted and future costs would grow.

The advocacy by the hospital and health system associations comes shortly after Medical Society of the State of New York and Texas Medical Association called on their members to persuade Congress to implement two-year ICD-10 delay until 2017. Those provider association have highlighted the negative financial implications for physician practices if an industry-wide ICD-10 implementation failed on Oct. 1, 2015.  The letter’s timing of December 5 also coincides with the message delivered by the Coalition for ICD-10 following remarks by American Medical Association President Robert Wah, MD, that contained arguments against and jokes about new code set.

Based on the types of organizations working in favor and against an additional ICD-10, a division clearly exists between hospitals and hospitals and physician practices. While advocates for the latter reiterate the readiness of their constituents, their counterparts see nothing bad negative consequences ahead for their members. And this division likely to puts to be any lingering doubts about the forces behind the most recent ICD-10 delay.

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New Calls for Meaningful Use Reporting Changes, ICD-10 Delay |

New Calls for Meaningful Use Reporting Changes, ICD-10 Delay | | EHR and Health IT Consulting |
HIMSS is seeking less stringent 2015 meaningful use reporting requirements while the Medical Society of the State of New York is petitioning for another ICD-10 delay.
While one industry association is calling on its members to support legislation that would make changes to 2015 meaningful use reporting, another is urging Congress to consider legislating an additional two-year delay for ICD-10 compliance.
As first reported by the Journal of AHIMA, the Medical Society of the State of New York began passing around a letter to members of Congress asking to delay the ICD-10 transition until October 2017 “in order to allow for physicians to work thru the myriad of new government regulations that face us.”
The provider association has highlighted the financial implications of a failed industry-wide ICD-10 implementation on Oct. 1, 2015.
“The onerous penalties tied to these mandates add to the hysteria that is running through physicians’ offices and is generating many early retirements,” the letter states. “If every entity in the complex medical payment pyramid does not function perfectly on October 1, 2015 then physicians’ income goes to zero which is a steep price to pay for a new imperfect coding system.”
The medical society is calling on members of the House Energy and Commerce Committee to include the two-year delay as part of “must pass piece of legislation during the upcoming Lame Duck Session in 2014.”
The move by the Medical Society of the State of New York mirrors that of the Texas Medical Association, which is advocating for a similar two-year ICD-10 delay.
Also calling for legislative action is HIMSS which has put out a message to its members to contact their representatives in Congress about the Flexibility in Health IT Reporting (Flex-IT) Act of 2014. The bill (HR 5481) introduced in September by Representatives Renee Ellmers (R-NC) and James Matheson (D-UT) would replace the full-year reporting for meaningful use in 2015 with a quarterly one.
HIMSS, which supports the bill, is looking to galvanize support among its constituents. “Members of Congress are not hearing from their constituents about 2015 Meaningful Use Reporting Period and that is where you can help! HIMSS is engaged in an effort to let members of Congress hear from their constituents about this important issue.”
Falling short of the bill’s passage, the industry association foresees the potential for Congress to consider other legislative avenues in the future. “Even without this bill passing, with enough Congressional support CMS may be persuaded to change the current policy,” the group maintains.
This legislation also has the support of the College of Healthcare Information Management Executives (CHIME), which has repeatedly called on the Centers for Medicare & Medicaid Services to reconsider meaningful use requirements in 2015 just as the federal agency showed a willingness to do in 2014.
“The misstep by officials to require a full-year of reporting using 2014 Edition certified EHR Technology (CEHRT) in 2015 puts many eligible hospitals and physicians at risk of not meeting Meaningful Use next year and hinders the intended impact of the program,” the organization stated in September. “To date; only 143 hospitals have met Stage 2 to date, representing a very small percentage of the 3,800 hospitals required to be Stage 2-ready within the next 14 days.”

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It's not too early to start hating ICD-11 coding

It's not too early to start hating ICD-11 coding | EHR and Health IT Consulting |

Just in case you were wondering, ICD-11 will not be a substitute for ICD-10 implementation. Joyce Frieden reminds us that ICD-11 is expected for release in 2017.

Note that an ICD-11 release doesn't mean it's good to go. Release means healthcare professionals can start reviewing it and learning it.

Since it's supposed to be based upon ICD-10-CM, there will be plenty for U.S. healthcare organizations to complain about. So there will be tweaking.

And of course there will be the campaign to delay ICD-11 implementation because ICD-12 coding will be so much better.

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AMA Pushes for Two Year ICD-10 Delay

AMA Pushes for Two Year ICD-10 Delay | EHR and Health IT Consulting |
AHIMA Statement on ICD-10 Delay

AHIMA continues to support an October 1, 2015 deadline for implementing ICD-10-CM/PCS. The industry has already seen two delays in implementation, and each delay has cost the industry billions of dollars, as well as the untold costs of lost benefits from implementing a more effective code set. Recent research published by AHIMA has shown that the estimated costs, time, and resources required by physician offices to convert to ICD-10 are lower than initially estimated. And a recent survey conducted by AHIMA and the e-Health Initiative shows that the healthcare community recognizes the long-term benefits of using ICD-10 and is making good progress in getting ready for implementation.

Another ICD-10 delay will only further deter progress and cost the industry money. There is no benefit to deferring implementation.

We reached out to AHIMA to ask them several questions on this latest twist to an ICD-10 delay. Responses are from Sue Bowman, MJ, RHIA, CCS, FAHIMA and Senior Director, Coding Policy and Compliance | Public Policy & Government Relations at AHIMA.

The American Medical Association and its regional associations are pushing to add language to a fiscal year 2015 appropriations bill for HHS that would grant an additional two-year extension to ICD-10. If such a delay were to go into effect, what would be the long term impact?
An additional delay to ICD-10 implementation would be disastrous from a healthcare data perspective. There is no benefit to continuing to use an outdated coding system that is not current with today’s clinical practices. We would lose a lot of ground as an industry in moving toward better decision making based on data. Furthermore, stakeholders that have already invested significant resources in training staff and making changes to workflows and processes will find themselves at a standstill, or burning money maintaining dual coding systems. The last two delays have already generated tremendous, wasteful costs–literally billions of dollars–and we really can’t afford another.

In a recent study conducted by AHIMA, results indicate the cost for physicians to convert to ICD-10 is lower than originally estimated. Another AHIMA survey shows healthcare providers recognize the long term benefits of using ICD-10. Considering what these two survey reflect about providers’ views of making the transition, what do you see as the reasons for the disconnect between providers and associations like AMA?
Part of the reason for the “disconnect” may be the misinformation and scare tactics that have circulated in the physician community–that ICD-10 is too expensive, too difficult to learn, and too complex to implement. These mischaracterizations were repeated so often people began to believe them, so they are unreasonably scared of the transition. It’s unfortunate, because the industry has had years to prepare for this change. Remember, the final rule was published in 2009. Those who advocate for delays have already gotten two of them. The Centers for Medicare & Medicaid Services and others have created many free and low-cost resources to help providers prepare. We really can’t see that there is any excuse for not being ready.

If there is an ICD-10 delay again, what new directions will the HIM industry take in 2015?
AHIMA’s members, our partners the ICD-10 Coalition, and many other stakeholders are advocating aggressively to prevent such a delay. Since there is no benefit to another delay, our focus remains helping the industry prepare for the October 1, 2015, implementation date, when we will transition from an archaic coding system to one that gives us better data and–as a result–more effective, safer, and better patient care.

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