Lawmakers May Let October Medical-Code Deadline Stick

Posted April 24, 2015 at 3:21pm

The United States appears poised to join much of the developed world in switching over to a system of medical billing codes that was adopted in France, the United Kingdom, Australia and Germany more than a decade ago.

Responding to concerns by some physicians and the American Medical Association, Congress last year extended a deadline to implement the ICD-10 billing system by one year to Oct. 1, 2015, as part of a temporary “doc fix” bill that blocked a scheduled cut in Medicare payments to doctors. No such extension was included in the recently enacted law that changes the health program’s physician payment formula.

Key lawmakers, including House Energy and Commerce Chairman Fred Upton, R-Mich., and Joe Pitts, R-Pa., the chairman of the committee’s health panel, support sticking with the current deadline.

“It seems almost certain that they are actually going to let it happen this time,” said Dan Haley, vice president, government and regulatory affairs at athenahealth Inc., an information technology company based in Watertown, Mass.

The Centers for Medicare and Medicaid Services on April 8 announced a social media campaign to spread the word about the Oct. 1 deadline. CMS is the agency overseeing the adoption of the codes, which will also be used by insurance companies as well as by the federal health programs.

CMS says in its campaign that the billing codes now in use, ICD-9, are more than 30 years old and don’t reflect much of what has changed in medical practices since the 1980s.

“Using ICD-10, doctors can capture much more information, meaning they can better understand important details about the patient’s health than with ICD-9,” CMS said. “The level of detail that is provided by ICD-10 also means researchers and public health officials can better track diseases and health outcomes.”

For many of those who work in health information technology, one of the most auspicious signs for a 2015 adoption of the ICD-10 codes has come from the AMA.

In a March letter to the Centers for Medicare and Medicaid Services, the influential doctors lobby didn’t ask for another extension. Instead, the AMA asked the agency to have contingency plans for cases where disruptions due to the ICD-10 switchover would delay reimbursements to doctors.


Laying the Groundwork

Like hospitals and insurance companies, many physician practices have prepared for the conversion to the new system, said Protima Advani, a vice president with consultant Avalere Health. The AMA is seeking protection for those that not yet done so.

“We are seeing the medical societies shifting their focus from delaying ICD-10 to ensuring CMS has contingency plans for those laggard practices that still may not be completely ready and experience challenges come Oct. 1, 2015,” Advani said of the AMA letter.

For doctors in small practices, the adoption of ICD-10 has been a challenge. It’s been seen as a distraction as time when they also must work to adopt new electronic health records systems to meet another federal mandate. The switchover can cost $50,000 to $250,000 for small practices, factoring in the potential for denial claims, lost productivity of office and medical staff and fees for vendors, William Jefferson Terry, a doctor representing the American Urological Association, told a House Energy and Commerce panel at a February hearing.

“Physicians are overwhelmed with the tsunami of regulations that have significantly increased the work of our practices,” Terry said, adding that this could trigger early retirements that would leave many patients without ready access to medical care.

Experts in health information technology and hospital and insurance executives point out that any further delay to ICD-10 will cost the nation’s health system significant money. The price tag for the most recent one-year delay may have topped $6 billion, according to estimates from the Department of Health and Human Services.

HHS pegged the cost for commercial health plans and certain administrators at $547 million to $2.79 billion, and for hospitals and large providers of health care at $409 million to $3.7 billion. In addition, the combined extra cost for Medicare and Medicaid in halting work underway toward using ICD-10 and continuing another year with ICD-9 may have topped $200 million, according to HHS.