Does Missing ICD-10 Delay in SGR Fix Strengthen Healthcare?
By - Preceding the Senate’s upcoming vote next week on Monday, April 13 following a two-week hiatus on the Sustainable Growth Rate (SGR) reform bill, H.R.2, the Medicare Access and CHIP Reauthorization Act, industry wide speculation abounds about whether or not vendors, payers, and providers lack ICD-10 preparation.
Sue Bowman, MJ, RHIA, CCS, FAHIMA, Senior Director, Coding Policy and Compliance, of the American Health Information Management Association (AHIMA), spoke with RevCycleIntelligence.com this week to clarify the organization’s perspective on the implications of an exclusion of delay language regarding an ICD-10 extension from the House of Representative’s March 26 approval of the SGR reform bill.
Bowman says there is tremendous support and pressure from both the healthcare industry and the physician community at large to pass the legislation and put a welcome end to temporary annual fixes.
RevCycleIntelligence.com: What are your predictions for whether or not the current ICD-10 deadline will remain in place?
Sue Bowman: Nobody really knows for sure. I don’t have a crystal ball but I would say all things are looking pretty good. A lot of organizations have been doing surveys showing by and large much of the industry is on track and getting ready for that October 1 date. I think all signs are positive.
We’ve already had two delays and one thing that’s very evident from both delays is the fact that they didn’t help anyone. In fact, people tended to get more behind and less on track as a result of the delay. What happened with the delay is kind of like anytime you get an extension on something -- what do you do? You put it aside and you wait until the date is closer.
After last year, when it was kind of a surprise to have a delay, people who poured a lot of money into getting ready were burned. Now, people are not as ready as they were last year in some cases. I think they’ll catch up but clearly a delay is not helpful to anyone. I don’t think another delay would be beneficial, even for the people that are still behind.
Recent studies have shown the cost for implementing ICD-10 for a small physician practice is a few thousand dollars, not the hundreds of thousands of dollars some people had projected in the past. If people get ready and they test with their payers and they’re on track on October 1, there’s no reason to expect that things won’t move smoothly forward, without significant disruption or lengthy payment delays. The key is making sure you’re prepared.
RCI.com: What are the primary benefits of the ICD-10 free SGR repeal for the healthcare industry at large?
SB: From our perspective, ICD-10 being absent from the SGR reform bill was a benefit. It also sends a message that [the healthcare industry] shouldn’t count on another delay. A delay does not appear likely and you need to get ready for the compliance date.
One of the biggest barriers to getting ready is a feeling of uncertainty about the date and whether they’ll be another delay. As time moves along and as we get past this major risk point without delay language, it sends a stronger message to the industry that it’s time to get ready and don’t count on another delay.
From our perspective, a delay is not only unnecessary, it’s not a solution to any of the problems that have been raised, such as financial disruptions immediately following the transition. I find the whole concept of a delay somewhat interesting because it’s not clear what problem a delay would solve. If people think it would improve readiness, it’s been delayed twice without improvement in readiness.
Some of us have been involved with ICD-10 for more than ten years. Just getting to ICD-10 adoption has been a long delay process. Replacement of the outdated ICD-9 code set with the more modern and precise ICD-10 is long-overdue.
RCI.com: Is further delay necessary?
SB: It’s not clear to me what even the proponents of a delay think a delay would gain them other than pushing it down the road so they don’t have to think about it for a while longer. It just isn’t really clear to me that it’s any kind of solution for any of the problems or concerns the people wanting a delay are worried about.
RCI.com: What is the possibility of Senate rejection?
SB: That’s probably another one where I would need my crystal ball. But it seems like all indications are pretty positive that the Senate will pass it.
Before the recess, Senate Majority Leader [Mitch] McConnell predicted passage. This was a bipartisan bill and it passed by a large majority in the House. And President Obama has said he will sign the bill. We won’t know the final outcome until next week, but I would be very surprised if the Senate doesn’t pass the bill.
