Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

Coalition for ICD-10, CMS Release Post-ICD-10 Statements

By Jacqueline DiChiara

- ICD-10 implementation is officially underway as October 1, 2015 has now come and gone. Physicians, healthcare providers, and healthcare professionals are allegedly still standing, albeit perhaps merely for now. 

icd-10 Medicare claims

As reported, despite the presence of a grace period, 93 percent of physicians expect ICD-10 payment delays to occur shortly.

As Cerner Corporation stated in a recent interview, ICD-10 will likely not be a short-lived Y2K-type event, but an extended process requiring keen collaboration and strengthened communication efforts.

Added experts from Epstein Becker & Green Firm during another interview last week, training and work flow challenges are expected to continue well past October. 

In light of such data and concepts, reactions to what comes next from various healthcare leaders and experts are now slowly unfolding as the healthcare industry progresses through October and beyond.

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The Coalition for ICD-10, an advocacy group of hospitals, health plans, hospital and physician office coding experts, vendors, and the health information technology (HIT) community, has issued an October 1, 2015 statement in acknowledgement of ICD-10’s significance to the healthcare industry.

“The long-awaited U.S. transition to ICD-10 on October 1st is a historic moment for U.S. healthcare and a major milestone in the evolving transformation of our 21st century healthcare delivery system,” says the Coalition for ICD-10.

“As a result of the replacement of the obsolete ICD-9-CM with the more modern ICD-10-CM and ICD-10-PCS code sets, patients can look forward to complete, accurate, up-to-date diagnostic and procedural data necessary to achieve significant advances in the quality of care and more efficient healthcare administrative processes,” adds the Coalition.

“The Coalition for ICD-10 is very pleased that the U.S. healthcare industry can finally begin to leverage the many opportunities anticipated by the availability of better healthcare data – including improved patient outcomes, patient safety, and population health, lower healthcare costs, and adoption of new payment models that reward value,” the statement concludes.

As reported, the Coalition has previously confirmed views that an ICD-10 safe harbor is "dangerous" for physicians. Additionally, the organization actively pushed last summer for ICD-10 to kick off on October 1 without further delay.

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CMS confirms it will take weeks to assess the ICD-10 picture

The Centers for Medicare & Medicaid Services (CMS) additionally offered October 1 commentary via the organization’s blog.

“It will take a couple of weeks before we have the full picture of ICD-10 implementation because very few health care providers file claims on the same day a medical service is given. Most providers batch their claims and submit them every few days,” CMS confirms.

“Even after submission, Medicare claims take several days to be processed, and Medicare – by law – must wait two weeks before issuing payment. Medicaid claims can take up to 30 days to be submitted and processed by states. Because of these timeframes, we expect to know more about the transition to ICD-10 after completion of a full billing cycle,” the organization adds.

CMS, who has released numerous ICD-10 preparation resources recently, additionally confirms in light of a significant transition, it will be monitoring the transition in real time and addressing issues via the ICD-10 Coordination Center, CMS’s collected group of Medicare, Medicaid, billing, coding, and information technology systems experts.

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Adds CMS, ICD-10 resources are available if, and when, problems arise:

Perhaps it is worthy of note that some prominent healthcare organizations have mysteriously yet to address the aforementioned “historic” and “significant” ICD-10 implementation in any shape or form, either via press releases containing statements or within social media outlets. Nonetheless, other statements aside from those released by the Coalition for ICD-10 and CMS have been rolling in throughout the past week from leading healthcare organizations.

As reported live last week from New Orleans at AHIMA’s 2015 Convention and Exhibit, AHIMA confirmed within a public statement that ICD-10’s greater level of detail within code sets will help tell a more accurate patient story.

“Following years of training, testing and collaboration, October 1 will be a momentous day for the healthcare industry and the patients we serve when the ICD-10-CM/PCS code set makes its long-awaited debut,” stated AHIMA’s CEO, Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA, within a public statement.

If CMS’s predictions are indeed correct and the healthcare industry has essentially just been successfully playing the hurry-up-and-wait ICD-10 game, perhaps it is merely the passing of time that will determine what comes next regarding upcoming bursts of the revenue cycle bubble.


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