November 16, 2012
A clarification from CMS on M1018 and nephrostomy tubes …
Question: When answering M1018, if client has a nephrostomy tube do you mark indwelling/suprapubic catheter?
Answer from CMS: If the nephrostomy tube is utilized for urinary drainage, it is an indwelling
catheter, therefore Response 2 – Indwelling/suprapubic catheter would be selected.
See more Q&As.
May 8, 2012
Just a reminder that the comment period on potentially delaying ICD-10 from Oct. 1, 2013, to Oct. 1, 2014, closes May 17 at 5pm EDT.
See the proposed rule.
Get your comments in:
Electronically by following the ‘‘Submit a comment’’ instructions on the Regulations.gov
By regular mail:
Centers for Medicare & Medicaid Services
Department of Health and Human Services
P.O. Box 8013
Baltimore, MD 21244–8013
April 9, 2012
HHS is proposing a rule to delay ICD-10 implementation until Oct. 1, 2014.
The new date is part of a proposed rule that would adopt a standard for a unique health plan identifier (HPID), adopt a data element that would serve as an “other entity” identifier (OEID), and add a National Provider Identifier (NPI) requirement.
Here is the press release.
The proposed rule is CMS-0040-P and you can see it at the Federal Registrar website.
March 26, 2012
The HHS Office of the Inspector General conducted a study looking at home health claims from 2002-2008 and found that$432 million in Medicare monies were inappropriately paid either because medical necessity was not established or coding was inaccurate. Millions more dollars were lost to CMS or HHAs because of upcoding or downcoding.
The number of HHAs grew from 7,052 to 9,801, and increase of 39 percent. Medicare spending on home health increased 84 percent from $8.5 billion in 2000 to $15.7 billion in 2007. The sharp rise in payments created the push to investigate payments.
HHS reviewed the claims of almost 500 beneficiaries to see whether Medicare coverage requirements were met.
The office found that 22 percent of claims were in error because services were not medically necessary or claims were coded inaccurately, resulting in $432 million in improper Medicare payments. Also, HHAs upcoded about 10 percent ($278 million) of claims and downcoded about 10 percent ($184 million) of claims.
OIG believes it needs to investigate more to determine what services are met and what potential for fraud is involved.
Read the complete report.
February 24, 2012
I looked at this communication from AHIMA and thought “This is good!” Fight for ICD-10!
We appreciate your continued support and willingness to help us communicate the detriment to the healthcare industry should ICD-10 be delayed. AHIMA stands strong with its position to “stay the course” and continue to plan and prepare for the ICD-10 transition.
Many of you have asked what you can do and say to help support the mission to not delay ICD-10. It’s important for all of us to talk from one, unified voice. To assist us in that goal, AHIMA has developed a list—“Ten for 10: Top Ten Reasons We Need ICD-10 Now.” We encourage you to use these messages and add your personal experiences to show real life examples of how an ICD-10 delay would greatly impact progress and resources that have already been invested in the transition. One of the first places we need to speak up is in the organization where we are employed. Already, surveys are being taken by employer associations like the American Hospital Association and other employers, both providers and health plans, to determine readiness. We need to be ready for ICD-10 and our individual organizations need to continue to work toward compliance on October 1, 2013. We need you and your employer to tell HHS and others of this commitment in order to back up our message of no delay and continued implementation. Besides the Ten for 10 below there is much more information on the AHIMA ICD-10 webpage. Use this information and keep watching for messages via the e-Alert as well as from your state association or delegates.
Thank you again for your continued commitment to advance HIM and your dedication to AHIMA. We will keep you up to date as we move forward.
Lynne Thomas Gordon, CEO, MBA, RHIA, FACHE
Ten for 10: Top Ten Reasons We Need ICD-10 Now
- It Enhances Quality Measures. Without ICD-10 data, serious gaps will remain in the healthcare community’s ability to extract important patient health information needed for physicians and others to measure quality care.
- Research Capabilities Will Improve Patient Care. Data could be used in a more meaningful way to enable better understanding of complications, better design of clinically robust algorithms, and better tracking of the outcomes of care. Greater detail offers the ability to discover previously-unrecognized relationships or uncover phenomenon such as incipient epidemics early.
- Significant Progress Has Already Been Made. For several years, hospitals and healthcare systems, health plans, vendors and academic institutions have been preparing in good faith to put systems in place to transition to ICD-10. A delay would cause an unnecessary setback.
- Education Programs Are Underway. To ready the next generation of HIM professionals, academic institutions have set their curriculum for two-year, four-year, and graduate programs to include ICD-10.
- Other Healthcare Initiatives Need ICD-10. ICD-10 is the foundation needed to support other national healthcare initiatives such as meaningful use, value-based purchasing, payment reform, quality reporting and accountable care organizations. Electronic health record systems being adopted today are ICD-10 compatible. Without ICD-10, the value of these other efforts is greatly diminished.
- It Reduces Fraud. With ICD-10, the detail of health procedures will be easier to track, reducing opportunities for unscrupulous practitioners to cheat the system.
- It Promotes Cost Effectiveness. More accurate information will reduce waste, lead to more accurate reimbursement and help ensure that healthcare dollars are used efficiently.
If ICD-10 Is Delayed:
- Resources Will Be Lost. For the last three years, the healthcare community has invested millions of dollars analyzing their systems, aligning resources and training staff for the ICD-10 transition.
- Costs Will Increase. A delay will cause increased implementation costs, as many healthcare providers and health plans will need to maintain two systems (ICD-9 and ICD-10). Delaying ICD-10 increases the cost of keeping personnel trained and prepared for the transition. Other systems, business processes, and operational elements also will need upgrading. More resources will be needed to repeat some implementation activities if ICD-10 is delayed.
- Jobs Will Be Lost. To prepare for the transition, many hospitals and healthcare providers have hired additional staff whose jobs will be affected if ICD-10 is delayed.
We Can’t Wait for ICD-11. The foundations of ICD-11 rest on ICD-10 and the foundation must be laid before a solid structure can be built. ICD-11 will require the development and integration of a new clinical modification system. Even under ideal circumstances, ICD-11 is still several years away from being ready for implementation in the United States.
February 17, 2012
A statement from AHIMA:
This week’s announcement from Health and Human Services (HHS) to pursue a delay was indeed a disappointment for all of us who have worked so hard to support the implementation of ICD-10. This surprise announcement reaffirms that AHIMA’s leadership on ICD-10 has never been more important. AHIMA is committed to advocating for ICD-10 to be implemented as soon as possible.
In the coming hours, days and weeks, we will be reaching out to those making the decisions to educate them about the importance of ICD-10 and encourage them to keep this delay as short as possible. You and I know the benefits to implementing ICD-10 are enormous—it will make our healthcare system more efficient and cost effective, and the richer data provided by ICD-10 will help improve the quality of healthcare for all patients. We also know that many of you have been working in good faith to prepare for this deadline.
We are meeting today to discuss short- and long-term strategies for addressing this challenge and will be calling on you for your support. In the meantime, we encourage you to maintain your vigilance in preparation for ICD-10 and to offer your expertise to others. As you know, AHIMA is here to help as the industry makes this change.
Thank you for your continued commitment to advance HIM and your dedication to AHIMA. We will keep you up to date as we move forward.
Lynne Thomas Gordon, MBA, RHIA, FACHE, AHIMA Chief Executive Officer
February 17, 2012
Don’t you think its funny that the webpage notices are titled “ICD-10-CM is coming Oct 1, 2013″ with byline “It’s closer than it seems” followed by “HHS Announces Intent to Delay ICD-10-CM”?
So what’s my theory on why CMS “intends” to delay implementation? I have a couple.
First, physicians are raising a big ruckus about ICD-10. I can understand why when Medicare cuts their payment by 27% and then requires compliance with something this huge. So is CMS listening? I think it boils down to it’s an election year and, lo and behold, President Obama decides to reduce regulatory burden by delaying a regulation that has been finalized since 2009. My opinion is that continuing to use an antiquated system like ICD-9-CM increases regulatory burden. Health plans, hospital systems and other payors and providers, including HHS, have spent millions of dollars readying for ICD-10-CM. A delay now will increase the money spent and the time spent.
Second, the United States has long been behind the rest of the world in coding. A friend told me once that the folks at the World Health Organization (WHO) make fun of us because we are so far behind. Those nations now using ICD-10 are getting ready for a move to ICD-11 October 1, 2015. Does that date seem familiar? Just maybe we are going to switch gears, skip ICD-10-CM and we’ll keep up with the rest of the world with ICD-11-CM in our near future, i.e., Oct 1, 2015.
February 16, 2012
A news release issued by HHS today:
As part of President Obama’s commitment to reducing regulatory burden, Health and Human Services Secretary Kathleen G. Sebelius today announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).
The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013 – a delay of two years from the compliance date initially specified in the 2008 proposed rule. HHS will announce a new compliance date moving forward.
“ICD-10 codes are important to many positive improvements in our health care system,” said HHS Secretary Kathleen Sebelius. “We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead. We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.”
ICD-10 codes provide more robust and specific data that will help improve patient care and enable the exchange of our health care data with that of the rest of the world that has long been using ICD-10. Entities covered under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will be required to use the ICD-10 diagnostic and procedure codes.