ICD-10 Implementation Delayed One Year

In a controversial move for the medical billing and coding profession, the president signed a bill into law that would delay the implementation of the ICD-10. This was no April fools joke. Known as the Protecting Access to Medicare Act of 2014, the bill drew the most attention for delaying cuts in the Medicare reimbursement rate for doctors. The delay of the ICD-10’s implementation until October 2015 was done almost as an afterthought.

Cuts for payments to doctors who treat Medicare patients are supposed to have been taking place every year since 1997, in a formula determined by the Centers for Medicaid and Medicare Services (CMS) known as the Sustainable Growth Rate (SGR). Yet for over a decade legislation has been passed each year which delays these cuts, known casually as “doc fix,” a term which also applies to this most recent bill. In this instance, the delay of the ICD-10 for another year was also thrown in as part of the bill.

In the nearly 70-page bill containing 225 sections, section 212 contains one sentence that sealed this most recent fate of the ICD-10.

Why, the attentive reader might ask, would these two seemingly unrelated topics be combined together in a single piece of legislation. As is usually the case when this occurs in legislation, the answer lies behind the scenes.

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Many physicians had been opposed to the October 2013 deadline to implement the ICD-10, citing reasons including the overall cost to transfer to the new system, a lack of readiness by vendors who sell medical billing and coding software, and the disruptions the switch would cause to cash flow. The largest organization of medical students and physicians in the United States, the American Medical Association (AMA) has been one of the most outspoken critics of the October 2013 changeover, and has steadily worked to lobby congress and the president against this. Most recently this has included a seven-page letter to the Secretary of the Heath and Human Services Department on February 12th.

In addition to the AMA, associations such as the American Academy of Family Physicians (AAFP), and Medical Group Management Association also favored the delay.

It appears the lobbying against the transfer has been successful, and this is at least one of the reasons why the delay of the ICD-10 transition was included in the most recent doc fix legislation. The implementation of the ICD-10 is with no lack of controversy with good points to be made by both its opponents and detractors.

Although the AMA has estimated that implementing the ICD-10 could cost small practices up to $226,000 in disrupted cash flow and reduced productivity, many larger health care providers have already spent millions of dollars on impact studies and implementation procedures based on the October 2013 deadline.

The American Health Information Management Association (AHIMA) lobbied against this most current bill. In a recent report, CMS estimated that the year delay would cost the health care industry between $1 and $6.6 billion. And it goes without saying that medical billing and coding professionals, along with everyone else in the health care industry, will now have more time to practice using the new set of codes.