The U.S. Department of Health and Human Services' (HHS) Secretary Kathleen Sebelius launched a final rule to make definitive a one-year proposed delay—from Oct. 1, 2013, to Oct. 1, 2014—in the compliance date for use of new codes that classify diseases and health problems. The final rule also establishes a unique health plan identifier.
These code sets, known as the International Classification of Diseases, 10th Edition diagnosis and procedure codes, or ICD-10, will include an increased number of codes for new procedures and diagnoses that improve the quality of information available for quality improvement and payment purposes.
"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," HHS said in the rule. "By allowing more time to prepare, covered entities may be able to avoid costly obstacles that would otherwise emerge while in production."
The agency also announced the final rule will save time and money for physicians and other healthcare providers by establishing a unique health plan identifier. “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,” Sebelius said.
Currently, when a healthcare provider bills a health plan, that plan may use a wide range of different identifiers that do not have a standard format. As a result, healthcare providers run into a number of problems, such as misrouting of transactions, rejection of transactions due to insurance identification errors and difficulty determining patient eligibility. The change will seek to simplify these processes, according to the agency.
The College of Healthcare Information Management Executives (CHIME) said it "is pleased that CMS understood the importance of finalizing its proposed one year delay for compliance to ICD-10,” said CHIME's President and CEO Richard A. Correll. “In public comments filed last April, CHIME urged CMS to keep its proposed one year delay because a longer delay would seriously disrupt ongoing efforts to convert to ICD-10. And, as HHS itself recognizes, a longer delay would significantly increase the costs of converting to ICD-10. Overall CHIME applauds the efforts of HHS to quickly and decisively signal a commitment to ICD-10 conversion and we urge the Department to develop a clear path forward, with benchmarks, so that healthcare industry stakeholders can make the conversion in 2014. "
However, not everyone is completely pleased by the new final rule, as Susan Turney, MD, president and CEO of MGMA-ACMPE, issued a statement with these remarks: "Despite the additional year for ICD-10 implementation, MGMA remains concerned that the CMS has mandated this new code set without having undertaken the necessary due diligence to ensure it will not create debilitating cash flow disruptions for physician practices. Also, we are not confident that critical trading partners, including Medicare and state Medicaid plans, will be ready in time to conduct testing well in advance of the October 2014 compliance date. We urge CMS to significantly escalate its implementation efforts by pilot testing ICD-10, ensuring health plan, clearinghouse and vendor readiness, and developing comprehensive educational resources."
Also, Turney added that the association is also "disappointed that CMS missed a significant administrative simplification opportunity to create true claims revenue cycle transparency with the health plan identifier rule. By not requiring health plans to enumerate at a more granular level, physicians will continue to face the burden of manually identifying these entities."