ICD-10 Delay… Again. Team Ready v. Team Tardy.

By: Ray Jorgensen

Categories: Billing, CHC, PMG Insights Blog

March 28, 2014

By now you have most likely heard about the probable delay of ICD-10, again.  H.R. 4302-Protecting Access to Medicare was passed by the House of Representatives and in all probability should breeze through the Senate before being signed into law by President Obama.  Aside from the standard (i.e., essentially annual) “Medicare Pay Fix,” this bill, once law will delay ICD-10’s start date until October 1, 2015.  This puts everyone in basically one of two camps… those who got ICD-10 ready (i.e., Team Ready) and those who did not (i.e., Team Tardy). Following are thoughts for those in both camps.

Team Ready

(NOTE: PMG’s revenue cycle management (RCM, a.k.a., billing)

AND PMG-Consulting’s ICD-10 clients… this is you!!)

  • Like someone preparing for a road race or athletic event that gets postponed… do you really want to let all that hard work go to waste? You prepared, trained, and made the effort to get in shape. Don’t become a couch potato after all the work you’ve done to get here now.
  • Start using ICD-10 as planned no later than October 1, 2014 allowing your billing team to crosswalk the ICD-10 code back to the ICD-9 code. 
  • By actual implementation timeline in 2015 or beyond, your team is seasoned and ready to accept ICD-10 transition like it was nothing.

Team Tardy

  • No matter what we say or recommend, procrastination may be your standard modus operandi.
  • We will tell you (again) to start (now) to:
    • Evaluate your current ICD documentation through chart audit,
    • Make certain you are on the most current version/release offered by your EMR/EHR and practice management vendor,
      • Only this release can concurrently manage ICD-9 and ICD-10 data files.
    • Train your providers on optimal documentation,
    • Search historic coding patterns for troubling trends, and
    • Find gaps in system operations where the shift from ICD-9 to ICD-10 will cause issues.

But these are not new suggestions. We at PMG are, frankly, disappointed to see the delay come forth. Mostly because most of those complaining loudest about not being ready will do what they did last time a postponement was afforded… absolutely nothing.  If you are a member of Team Ready, you will always be prepared. If you associate more with Team Tardy… Now is your chance to join the winning team!  

National provider entities and their lobbyists have stated that the majority of providers are simply not ready to move.  This transition is, however, not optional.  As the only industrialized nation in the world not using ICD-10, the U.S. is the weak link in the work of public health data.  It is a public health imperative to move to ICD-10.  AND, Congress passed a bill into law requiring ICD-10 as part of the national standardized code set.  

Perhaps more importantly, our CHC clients have proven time and again that the optimal motivator when attempting to bring about change in process or behavior is doing the right thing for the betterment of:

  • Patient care and outcomes,
  • The local and national healthcare community, and
  • The larger world of public health.

These are things our clients and their providers can get behind.  Moving purposefully to ICD-10 affords our national healthcare community the opportunity to:

  • Expand and more accurately capture the complex breadth of challenges seen in community-based medicine
    • Current ICD-9 data suggests CHC patients are the same or less complicated than those seen in private practice, which we know from first-hand experience to be false. 
  • The ability to share more meaningful data with the National Center for Vital Health Statistics (NCVHS) and the World Health Organization (WHO)
    • NCVHS exports mortality data to WHO annually but as a nation we cannot communicate internally at more than a cursory level regarding the complexities of disease being managed.
  • Enhance historically inadequate “assessment and plan” documentation to mitigate audit risk and/or jeopardized patient care.
    • If you have not done an ICD-9 audit recently, take a look and see if your providers’ documentation will pass ICD-9 scrutiny, never mind ICD-10.

We make no bones about the fact that we at PMG are hired to make our clients money.  Certainly, from a revenue perspective, maximization of risk-adjusted compensation is always a topic of interest. ICD-10 brings this opportunity forward. We must grasp it.

So, for now, if you are Team Ready… stay the course. You worked hard to get here so don’t backslide. Start using ICD-10 no later than October 1, 2014 and allow your practice management system to crosswalk back to ICD-9.

If you are Team Tardy… you may have already stopped reading… but make a bold break from a history of procrastination and start ICD-10 preparedness NOW. Initiate a move to ICD-10 for the betterment of your patients and public health.

By the entirety of the United States’ healthcare community enhancing their documentation and coding, we all collectively benefit from data on which we can depend and make the best decisions possible. We at PMG are committed to making certain our clients are best of breed in this regard. Thanks for allowing us to be your partners as we move boldly forward through the ever-changing complexities of our national healthcare system.