ICD-10 | EMR Thoughts

Cool is Great, but ICD-10 Is About Payment

I got the following email from a practice manager:

But here is a monster of a question for EMR/EHRs: In 510 days, ICD-10 and its 70,000 plus codes (as opposed to ICD-9′s 14,000 codes) will be on the necks of providers. How will the software handle that? It will have to keep both sets available, because old claims will still be under that system, and may even have to provide a “translator” function from one to the other. Not just a crosswalk, a decision rubric.

This is how the money gets made, and everyone wants to be paid. Cool may be awesome, but payment…well, that’s serious.

As my programmer daughter says, this is what computers do best, but a human has to program it to do that.

This comment is a really interesting one and reminds me of the hospital administrator I was with recently who talked about being overwhelmed with the administrative. ICD-10 is an example of the administrative that can be overwhelming and could have serious financial consequences if not dealt with appropriately.

Plus, the above comment highlights how many practices will be at the mercy of the EHR and other software programmers when it comes to ICD-10. I agree that ICD-10 won’t be an issue for many as long as the programmer does a good job implementing it. In fact, this is why the concept of dual coding ICD-10 is so important. However, as the linked article discusses, that’s not likely an option for a smaller clinic.

Either way, I’m interested in the core idea of being distracted by the shiny things so we miss out on the serious ones.

ICD-10 Delay Finalized with New Unique Plan Identifier

Another big week for healthcare IT and HHS. First, we got the meaningful use stage 2 final rule and now we have the official ICD-10 delay (See our previous post about the proposed ICD-10 delay). Here’s a quote from the announcement:

By delaying the compliance date of ICD-10 from Oct. 1, 2013 to Oct. 1, 2014, we are allowing more time for covered entities to prepare for the transition to ICD-10 and to conduct thorough testing.

This will be a welcome announcement for many in healthcare. Edifecs sent me the following comment about the delay which I think sums up most people’s feelings.

Edifecs commends HHS for finalizing its ruling on the ICD-10 one-year delay. We believe HHS has made the right decision and that a delay of this length strikes a fair compromise in meeting the needs of those healthcare entities that have already started down the ICD-10 path and those that have failed to either begin or show much progress. This one-year delay will give more time to those who need it and will also help those who were on track avoid the excessive costs an even longer delay would have created. Edifecs is encouraging its customers, and the entire healthcare industry, to continue moving forward with their ICD-10 implementations in order to meet the mandate ahead of schedule or on time.

That’s a pretty good word of caution. 2 years seems pretty far away, but that time will pass quickly.

Bigger news might even be the New national unique health plan identifier (HPID) that is being put in place. Sebelius explains, “These new standards are a part of our efforts to help providers and health plans spend less time filling out paperwork and more time seeing their patients.” I’ll be interested to learn more about this identifier and what insurance plans think of it.

5010 Enforcement Delayed by CMS

The Twitterverse is alive with people tweeting about the news that Modern Healthcare broke about CMS deciding to delay enforcement of 5010 until June 2012. Here’s a quote from the article:

The CMS will not begin enforcing the mandated move to Version 5010 transaction standards for an additional three months, until after June 30.

In some ways this is just delaying the inevitable and giving payers a reason to delay their 5010 implementation even more. However, there were likely so many practices that wouldn’t get paid under 5010 and many payers who would be paying using the non-compliant 4010 that this was probably a smart move to delay. For those not that familiar with some of the issues, here’s a good post about how practices should deal with the move from 4010 to 5010. The post highlights the challenge to a practice when some payers are on 5010 and others aren’t yet ready for it.

I’d been hearing a lot of rumblings about the challenges of 5010, so this isn’t that big of a surprise. Although, you can be sure that CMS didn’t want to delay 5010. Particularly since CMS had recently delayed ICD-10 implementation as well. Although, I think fewer people will complain about this 5010 delay compared with those still arguing against the ICD-10 delay.

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Cool is Great, but ICD-10 Is About Payment

ICD-10 Delay Finalized with New Unique Plan Identifier

5010 Enforcement Delayed by CMS

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