Congressional Communication & ICD-10
By Michael Baney, president, Woodham HIM Solutions
In a letter to CMS dated June 4, 2014, Congress made it clear that it wants providers to adopt the new coding system successfully in 2015. This letter comes in the wake of the federal government's delay of the new coding system this past spring. Congress' message for 2015 is clear: ICD-10-CM/PCS is coming, and the industry needs to be ready.
According to its recent letter, Congress says CMS must perform these four actions between now and October 1, 2015:
1. Provide ongoing communication regarding "progress in reaching meaningful milestones toward full ICD-10-CM/PCS readiness," including the following:
- Provide ICD-10-CM/PCS outreach and education for providers
- Allow stakeholders to participate in ICD-10-CM/PCS readiness planning
- Share best practice strategies for implementation
- Clearly describe the end-to-end testing that will occur - this includes information about whether the testing will occur directly with providers or indirectly with clearinghouses or others as well as how often it will occur
2. Explain why CMS delayed end-to-end testing until next year as well as provide a timeline for the new testing
3. Provide ongoing progress reports for ICD-10-CM/PCS activities, including expected timelines for completion
4. Keep tabs on stakeholder involvement and engagement in outreach, education, and testing
Will Congress' increased oversight of CMS improve the likelihood that we'll move forward with ICD-10-CM/PCS in 2015? That remains yet to be seen. One could argue that many of the barriers to ICD-10-CM/PCS that exist today will continue to exist in 2015. Increased oversight doesn't exactly target the root cause of the problem, i.e. physician resistance.
True progress will be made only when those who have opposed ICD-10-CM/PCS understand its value and are convinced that the new date will stick.
ICD-10-CM/PCS is the gateway to improved patient care. Work collaboratively with your physician practices to ensure they fully understand how the new code set drives more comprehensive data on which clinical research, cures and medical innovation will be based. Secondly, surgical denials will trickle down to negatively impact physician reimbursement-a key point to explore with your surgical services team.
The toughest challenge will be convincing physicians that October 1, 2015 is reality. There are many naysayers and skeptics. After all, the NGR "fix" has been repeatedly postponed and ICD-10 is now on its third delay. To counteract pessimism, hospital executives should keep up-to-date with all ICD-10 news and actively share information throughout the coming year.
Stay the Course
The healthcare industry has worked hard to prepare for this transition. All stakeholders must stay the course with ICD-10-CM/PCS implementation. Greater physician understanding alongside clearer Congressional communication may work together to ensure October 1, 2015 marks true progress in our healthcare system.