“The ICD-10 Delay: Where do we go from here?,” BY Anne L. Smith, RN, CPC,
CCS-P, CPMA, CPC-I, CEMC, CPEDC, AHIMA-Approved ICD-10-CM Trainer, May 2012
As most of you are probably well aware, the Department of Health and Human Services (HHS) has announced a proposed delay in the implementation of the ICD-10 diagnosis coding system for one year, until October 2014.
No doubt, many were quite surprised by the original announcement in February of the intent to delay, despite comments last fall from the American Medical Association (AMA) and other entities that they were campaigning for such action. Preparation had been underway at least to some extent by most health care providers, and many have already spent large amounts of money and time in planning and training for the implementation.
Reaction to the proposed delay is decidedly mixed. The AMA and many physician specialty societies and practices across the country have praised the actions of HHS. They have expressed serious concerns about the lack of readiness by health care providers, as well as the financial and operational burdens that ICD-10 entails – especially coming on the heels of health care reform, the electronic health record (EHR), and government programs such as “meaningful use.” On the other side of the debate are many of the organizations devoted to health information management and technology. They have issued several communications on the issue since the intent to delay ICD-10 was announced earlier this year, pointing out the importance of moving forward with what they describe as a much-needed improvement to current diagnosis coding and also their concerns that a delay itself will be costly to health care providers.
Finally, in the midst of all this uproar, there were even a few whispers that HHS should scrap ICD-10 altogether and plan to move directly to ICD-11 instead. (Be honest now, did you really even know there was an ICD-11 out there?) ICD-11 has been under development by the World Health Organization (WHO) for several years. Early indications are that it will be poised to take full advantage of the latest technology and will better meet the specific needs of primary care and specialties, in addition to focusing on current health care initiatives such as quality measurements. However, the WHO timeline for ICD-11 does not call for the final version to be ready until 2015 at the earliest and, meanwhile, industry experts tell us that ICD-9 is obsolete, does not reflect the needs of the 21st century and cannot maintain its viability that long (e.g., it is literally “running out of numbers”). Based on the recent announcement, however, it appears that ICD-10 will be implemented in 2014.
So what is a provider to do? Right now our best advice is to move forward cautiously, keeping watch for HHS to announce that the proposed delay has been finalized and forging ahead with required items (such as version 5010 for electronic administrative transactions, which has had its own compliance date delayed until June 30, 2012). Planning for ICD-10 should also continue, perhaps with a flexible timeline for training programs and other necessary preparations. As is often the case in health care, we will all need to “stay tuned” for further developments.
As many of you know, earlier this year we lost a good friend and the leader of Fredrikson Healthcare Consulting, Mike Reiling. We wanted to let you know that our healthcare consulting practice is now led by Mike's long time colleague and a principal of the practice, Anne Smith, who is working to provide a seamless transition for our clients. If you have any questions, please contact Anne or Steve Beck, Chair of Fredrikson's Health Group.
“Genie in a Bottle, or Pandora’s Box?,” Article printed in Minnesota Physician, posted January 2011
Historically, medical records have been in a paper format, but recent years have seen more and more clinicians moving to an electronic health record (EHR; sometimes referred to as electronic medical record, or EMR). Since there is no doubt that the EHR will be the standard going forward, it is crucial that physician practices use these great tools to their best advantage.
“Failure to E-Prescribe in 2011 May Result in a 1% Reduction in Medicare Reimbursement to Eligible Professionals in 2012,” BY KATHERINE A. BURKHART, Michael P. Reiling, and Anne L. Smith, December 2010
In the 2011 Physician Fee Schedule Final Rule, the Centers for Medicare and Medicaid Services (CMS) detailed its plan to begin penalizing “eligible professionals” who do not e-prescribe. (An “eligible professional” or “EP” is any physician or non-physician practitioner with prescribing authority.) In 2012, each “eligible professional” who is not a “successful electronic prescriber” will be subject to a 1% payment reduction of the EP’s Medicare Part B reimbursement. In 2013, the penalty will be a 1.5% payment reduction and, in 2014, there will be a 2% reduction.
The long-awaited Medicare coverage for preventive medicine visits is finally here! Effective
1-1-11, Medicare will cover an “Annual Wellness Visit.” More detailed information regarding this new Medicare benefit is expected, but the following is a summary of information already received.
The benefit is for patients who are more than 12 months out from the effective date of their first coverage period under Part B, and who have not have received either an Initial Preventive Physical Exam (the “Welcome to Medicare” physical) or another annual wellness visit within the past 12 months.
In addition to a health risk assessment (details to be determined), the Annual Wellness Visit includes a personalized prevention plan that consists of these elements:
- Establishment/update of the patient’s medical and family history
- List of current providers, suppliers and medications prescribed
- Measurement of height, weight, BMI or waist circumference, and blood pressure
- Detection of any cognitive impairment and establishment/update of an appropriate screening schedule for the next 5-10 years
- Voluntary advance care planning
- Establishment/update of risk factors and conditions, including mental health conditions
- Personalized health advice and referral, as appropriate, to health education or preventive counseling services or programs.
- Depression screening and functional status screening also are to be added as elements for the first annual wellness visit only
Two new HCPCS codes have been established for the annual wellness visit:
- G0438: Annual wellness visit, Personalized prevention plan, first visit
- G0439: Annual wellness visit, Personalized prevention plan, subsequent visit
The world of medical records is changing fast — there are new regulations, changing requirements, and bottom line incentives available to physicians and hospitals that can implement and use an electronic health record (EHR) system.