Hospitals to CMS: How will the ICD-10 delay work?

Obama signs law prohibiting agency from enforcing 2014 switch to new codes

President Obama on Tuesday signed a 12-month "doc fix" deal that will delay the implementation of ICD-10 until Oct. 1, 2015. But it's unclear exactly how that change will affect the rollout of the new diagnostic code set, Modern Healthcare reports.

Delays of the delay: Here's what we know

The ICD-10 delay—which was included, without much debate, in a broader bill to delay massive Medicare payment cuts for doctors—prohibits CMS from enforcing a mandate to switch from ICD-9 to ICD-10 until at least Oct. 1, 2015. The switch to ICD-10 means that health care providers and insurers will have to change out about 13,000 codes for more than 68,000 codes.

The decision surprised many in the health care industry who have spent hefty sums to meet the Oct. 1, 2014 deadline.

Devin Jopp—president and CEO of Workgroup for Electronic Data Interchange (WEDI)—told Modern Healthcare that the delay will be a blessing for some smaller providers who were not prepared for the switch.

But many in the industry are well into their transition to ICD-10 and are now unclear on whether they should continue their "dual-coding efforts."  

Dual Coding: Learn what it means for your hospital

What hospitals need to know to move forward

Since the law only prevents CMS from enforcing a mandate, many questions remain about how the delay will proceed, including:

  • Is Oct. 1, 2015, the new deadline to switch over?
  • Will CMS allow providers to make the switch to ICD-10 voluntarily?
  • Might the agency skip over ICD-10 altogether and skip straight to ICD-11, which is slated for release in 2017?

"We do need some guidance from CMS to make some decisions," Jopp says, adding, "For example, training. What should we do with training now?"

CIOs at hospitals, insurance companies, and other health care organizations do not want to lose the momentum they have built toward meeting a fall deadline, but they also want more clarity before they proceed. "My guess is, there are [CIOs] all over the country saying, 'How do I shelve this program?'" says Andrew Smith, president of Impact Advisors consulting firm.

While hospitals wait for guidance…

Some hospitals are moving forward with the assumption that CMS will allow hospitals to implement ICD-10 voluntarily. "We have been working furiously for the last year to be ready by Oct. 1, 2014," says Dan Robinson of Hill Physicians Medical Group, adding, "We are not going to take our foot of the pedal."

Hill Physicians Medical Group, which includes a network of 3,800 physicians, has invested $2.1 million in preparing for ICD-10 implementation. Robinson estimates that the new delay will increase their costs by at least 8% to 10%.

On the other side of the issue, Dave Clark—interim administrator for Hardeman County Memorial Hospital-Quanah in Texas—says the delay will help the 18-bed hospital stay in business. The hospital filed for bankruptcy last May, and Clark says the ICD-10 switch might have forced it to close its doors (Carlson/Robeznieks, Modern Healthcare, 4/1 [subscription required]).

What does it take to transition?

Learn about 20 imperatives to protect your revenue stream during and after your switch to ICD-10—and find out when how to spread them out over your transition timeline.

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