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ICD-10 delay impacts implementation of OASIS-C1 « CMS …

In a new S&C letter, “Outcome and Assessment Information Set (OASIS)-CI / International Classification of Diseases (ICD-)9 Webinar: September 3, 2014,” (Ref: S&C: 14-40-HHA), CMS notes that is has determined that the ICD-10 delay will have an impact on the Home Health Quality Reporting Program, especially the implementation of OASIS-CI. The new version of OASIS data set items was scheduled to be implemented on October 1, 2014, but five of these codes require the use of ICD-10 codes. The letter details the codes that require change.

Additional, the S&C group will be hosting a webinar, “OASIS-C1 / ICD-9” on September 3, 2014. The webinar will cover the OASIS-C1/ICD-9 data set and its implementation, the types of changes made to the data set and changes made to the OASIS-C1/ICD-9 Guidance Manual.

OASIS-C1/ICD-9 is scheduled to be implemented on January 1, 2015.

Read the S&C letter on the CMS website.

NCVHS Standards Subcommittee Panel Focuses on a Successful …

ICD 10

News Updates| July 11, 2014

Last month, ICD-10 was a featured topic at a meeting of the Standards Subcommittee of the National Committee on Vital and Health Statistics (NCVHS). Representatives from both the Centers for Medicare & Medicaid Services (CMS) and medical and trade associations testified during the panel “ICD-10: Achieving a Successful Transition.”

In light of the recently enacted legislation that delays the ICD-10 compliance date until at least October 1, 2015, several panelists urged the various components of the U.S. health care community to work together for a successful transition. They pointed to a need to rebuild credibility around the message that ICD-10 is coming and health care professionals need to prepare. Panelists from trade associations urged CMS to communicate its commitment to ICD-10 and to robust end-to-end testing with providers and clearinghouses. They also noted that collaboration across groups like payers, clearinghouses, and providers will be essential to successfully testing ICD-10.

CMS Commitment to ICD-10 and Testing
Denesecia Green, acting director of the Administrative Simplification Group, assured attendees that CMS is committed to ICD-10, including Medicare testing with providers and clearinghouses. She emphasized that CMS Medicare testing plans have been postponed—not canceled—saying “There will be testing.” To help mitigate risks around the ICD-10 transition, CMS is regularly bringing together payers, software/IT vendors, clearinghouses, and providers to collaborate on sharing best practices and overcoming challenges.

Representing Medicare fee-for-service (FFS), John Evangelist shared details about the Medicare acknowledgment testing that took place March 3-7. He noted that testers submitted more than 127,000 claims with ICD-10 codes to the Medicare FFS claims systems and received electronic acknowledgements confirming that their claims were accepted.

Approximately 2,600 participating providers, suppliers, billing companies, and clearinghouses participated in the testing week, representing about five percent of all submitters. Clearinghouses that submit claims on behalf of providers comprised the largest group of testers, submitting 50 percent of all test claims. Other testers included large and small physician practices, large and small hospitals, labs, ambulatory surgical centers, dialysis facilities, home health providers, and ambulance providers.

Nationally, CMS accepted 89 percent of the test claims, with some regions reporting acceptance rates as high as 99 percent. The normal FFS Medicare claims acceptance rates average 95-98 percent. Testing did not identify any issues with the Medicare FFS claims systems.

AAPC Study of Transition Costs
Rhonda Buckholtz, AAPC vice president for ICD-10 training and education, also testified to the ICD-10 panel about results from a study that her organization conducted of its members and others in the health care community. Among AAPC’s findings: ICD-10 transition costs were lower than previously estimated in other studies—an average of $1,600 per provider.

Of the 5,000 AAPC clients that responded via phone or online, 220 answered a question about their actual investment in ICD-10—a question that Ms. Buckholtz noted could be answered only by those who were “truly ready.” Respondents were asked to answer the question based on how much their vendors charged, how much they spent on education, and how much they spent on consultants. (These actual costs do not include staff time spent on training and education.)

Here’s how the costs broke down by practice size:

  • Small practices (fewer than 10 providers) = $750 per provider
  • Medium practices (10 – 49 providers) = $575 per provider
  • Large practices (50 or more providers) = $3,500 per provider

The costs do not account for additional expenses that may be incurred as a result of legislation delaying the ICD-10 compliance date.

If additional studies help to confirm that AAPC’s results reflect the actual costs for the transition to ICD-10 for diagnosis coding, it could alleviate concerns providers have expressed about costs.

Keep Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news and resources to help you prepare. Sign up for CMS ICD-10 Industry Email Updates and follow us on Twitter.

Learning disabilities – Math disability (ICD-10 and DSM-IV codes …

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ICD-10-CM Feature(s) | Journal of AHIMA | Online Medical Coding …

Healthcare Providers Lag on ICD 10 | CivSource

Earlier this year, the federal government intervened to extend the deadline for hospitals and other healthcare providers to implement a new type of medical coding called ICD-10. Typically, when patients seek treatment at a healthcare provider, those treatments are assigned billing codes so that hospitals, insurance companies, and federal programs like Medicare and Medicaid can make the appropriate payout for each part of the treatment.

US healthcare providers have been on the ICD-9 version of this coding framework since the 1970s, and lag behind the rest of the world in adopting ICD-10. Version 10 is updated to reflect new medical procedures, and new ways of providing and managing care. Healthcare providers in the US were coming up on the compliance deadline for this update, which requires significant retraining and modernization of administrative systems, and many parts of the US healthcare landscape were unsurprisingly lagging behind.

A recent survey of healthcare providers conducted by eHealth Initiative and the American Health Information Management Association (AHIMA), and sponsored by the health IT vendor Edifecs, shows that while few were on pace to meet the original deadline, half of respondents say that the delay will increase implementation costs by 11-25%. The new deadline will be October 1, 2015.

“To the extent that health plans use third-party administrators and other vendors to process health claims, the plan administrator must ensure that the vendors are ready to process claims using ICD-10 codes by the new compliance date,” says Amy Moore, Partner at Covington and Burling. This may turn out to be a tall order for healthcare providers that have shifted resources away from ICD 10 implementation now that they have more time.

Some providers, however, are continuing with implementation. Florida’s largest pediatric facility, Miami Children’s Hospital (MCH) has tapped Xerox for its ICD 10 work, and is moving forward. Xerox has created a coding and training solution that works through each phase of the change management process in addition to providing new coding technology. The offering uses simulation technology, similar to flight simulators pilots use in order to walk staff through the process.

“We’ll be ready when ICD-10 goes live,” said Ed Martinez, chief information officer at MCH.

Moore explains that it could take up to 23 months for payers to test their systems for compliance once they have implemented the updates, so the single year extension isn’t that much time, especially for providers that haven’t started.

“Providers run the risk of losing momentum if they use the extension to take the pressure off,” adds Heather Haugen, PhD and managing director of The Breakaway Group, a Xerox Company. She is working with MCH to implement the Xerox solution. “There is significant training and education required throughout all parts of a provider network. Not all ICD 10 product providers are going to do that the same way, and not all provider systems are created equal.”

ICD 10 is a key part of electronic health record implementation, as whole patient record systems need to be modernized including the billing codes. Sources at other providers say they’ve cancelled consultant contracts like Haugen’s, and are shifting resources away to other projects. As the new deadline approaches, those providers will have to start over, which is adding to implementation costs.

69% of providers in the AHIMA survey note that adding another year and pushing back implementation to 2016 would be catastrophic. Nearly the same percentage 67% say the delays aren’t improving readiness.

“I think you’ve seen some lobbying from providers who are holding back on implementation, and you’ve seen others who just don’t think it’s going to happen,” Haugen says. “It does create a segments in the healthcare system that you don’t find in other countries which operate at a national scale, and that does increase costs through to the US consumer. I think you see that realization at providers that are pushing ahead like MCH, because they’d rather not lose what they have in place. This is one part of a broader modernization effort.”

This reality is paramount for providers and US healthcare consumers. Between new health IT tools, and compliance changes like those in the Affordable Care Act, Meaningful Use guidelines, health information exchange guidelines, failure to implement isn’t really an option. Haugen expects that the educational materials like those put together by the Breakaway Group as a supplement to technology, will continue to expand, leaving providers who don’t act further and further behind.

“The technology is here, and the opportunities are here, but it’s definitely going to take providers a while to work through it. Some of that is a cultural issue, MCH understands that they have a duty to their patients and they have a sense of urgency. That view has really got to come from leadership and work its way through all corners of the organization to be successful,” Haugen said.