Medical Billing Forum

Coding => Coding => Topic started by: PMRNC on March 27, 2014, 01:16:23 PM

Title: ICD-10 DELAY coming.. just like I said it would
Post by: PMRNC on March 27, 2014, 01:16:23 PM
I can see Merry sitting there going..damn it she was right.. LOL <g>

They were set to vote today on the SGR and possible delay of ICD-10 (despite all times they said they wouldn't delay) but as usual, we are in LIMBO again.

http://journal.ahima.org/2014/03/27/house-passes-icd-10-delay-vote-ahima-calls-for-continued-advocacy/ 

NO VOTE..  I think they didn't order enough pizza. 
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: RichardP on March 27, 2014, 02:16:52 PM
NO VOTE..  I think they didn't order enough pizza.

Just to be clear, the House did vote on, and pass, this bill.  From the link:

Without formal warning, the bill was reintroduced Thursday afternoon and passed by a voice vote and without quorum. The move excluded several members of the House from the vote, and made it impossible to know exactly who would have voted for or against the measure.

The Senate has a similar bill, with similar language to delay the ICD-10, but they have not yet scheduled a vote.

If the Senate and House don't agree on a bill and pass it by March 31, Medicare payments to doctors will be automatically reduced by 24%.  So I think the Senate will vote on their bill before the end of Monday.  I think the House will hold firm in requiring the ICD-10 delay be part of the bill sent to the President for his signature.  We should know by Monday night which way the wind blows.
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: PMRNC on March 27, 2014, 02:24:37 PM
LOL the wind blowing determination was second on my list.
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: Merry on March 27, 2014, 06:16:51 PM
I would never admit you were right Linda.. Even if you were.. Lol
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: PMRNC on March 27, 2014, 06:23:12 PM
Quote
I would never admit you were right Linda.. Even if you were.. Lol

Doesn't change the fact I was right. LOL  :o ;) :)
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: PMRNC on March 27, 2014, 06:25:41 PM
http://www.washingtonpost.com/blogs/wonkblog/wp/2014/03/27/icd-10-might-be-delayed-again-how-will-we-know-when-squirrels-attack/

LOL.. oh no, we won't know when a squirrel attack takes place!!
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: RichardP on March 28, 2014, 01:31:16 AM
I particularly like ICD-10-CM Diagnosis Code W53.21XA:  Bitten by squirrel, initial encounter .

There is a different code for the subsequent encounter.  But you can only use that different code if the subsequent encounter / bite occurred in a different bodily location and at a different time.  You must use the modifier GNAW if subsequent bite(s) occurred within 5 minutes of the first one.
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: Michele on March 28, 2014, 05:44:44 AM
Haha!  I have seen some really funny ICD10 codes.  I think delaying it just prolongs the panic and worry of the providers.  They don't really understand what it will entail, they are trying to prepare, and they are being told "Don't Wait!!"  then it gets delayed??

Oh well, I keep telling my providers "don't get nervous, we are prepared, we will help you and your staff prepare, it will all be good."  I know that's a basic explanation.  Of course I am more detailed with them, just trying to point out that if you are taking the appropriate steps it doesn't have to be a horrible scary change.
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: PMRNC on March 28, 2014, 06:56:09 AM
You guys have to check this out. LOL

http://icd10illustrated.com/
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: Billing2 on March 28, 2014, 07:08:08 AM
I  really wish they would not delay. I think providers are going to get a little lazy about the whole thing now. I like struck by a dolphin. 
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: Michele on March 28, 2014, 08:49:33 AM
If nothing else ICD10 is giving us a some good laughs.  I wonder if they have a dx for encounter with an octopus?
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: PMRNC on March 28, 2014, 09:21:54 AM
Quote
I  really wish they would not delay. I think providers are going to get a little lazy about the whole thing now.

Thing is they were not going to be ready. We all would have, but carriers and Medicare wouldn't. Most carriers only rely on computerized data and edits and don't even train for new coding guidelines. So better to delay it than us all be compliant and ready and the payors won't be  :o ::)
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: RichardP on March 28, 2014, 11:25:18 AM
Linda, in the link you gave, there is this statement:

*as of 3/28, ICD-10 deadline has been pushed back to sometime in late 2015!

Is that just wishful thinking on their part, or do we have confirmation that the delay is official?

And, for Michele, just in case she needs to know this - my post about the squirrel was a joke.  The ICD-10 Code and definition is correct.  But the rest isn't.
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: DMK on March 28, 2014, 11:30:02 AM
HILARIOUS!!!! I thought there were some funny ICD-9 codes!  I just spoke with a mucky muck from Blue Shield the other day and they haven't even BEGUN to train for ICD-10.  The new HCFA was enough.  And XP. And...And...
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: Michele on March 28, 2014, 12:13:45 PM
Richard,

I knew that but it certainly was funny.  I like the 'GNAW' modifier.   ;D
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: shanbull on March 28, 2014, 12:44:54 PM
Linda, in the link you gave, there is this statement:

*as of 3/28, ICD-10 deadline has been pushed back to sometime in late 2015!

Is that just wishful thinking on their part, or do we have confirmation that the delay is official?

And, for Michele, just in case she needs to know this - my post about the squirrel was a joke.  The ICD-10 Code and definition is correct.  But the rest isn't.

The date is October 1, 2015 - the wording of the bill prohibits implementation of ICD-10 prior to that date. And it isn't official yet. The House passed the bill, but the Senate will not vote on it til Monday evening, as you previously posted. It's going to pass because it's still attached to the bill preventing reimbursement rates from falling 24% as of April 1st (the day after the vote). There isn't time to debate it. It's pretty much a foregone conclusion. It was a sneaky move, lol http://www.ihealthbeat.org/articles/2014/3/27/house-passes-doc-fix-that-includes-one-year-icd-10-delay (http://www.ihealthbeat.org/articles/2014/3/27/house-passes-doc-fix-that-includes-one-year-icd-10-delay)
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: PMRNC on March 28, 2014, 01:16:33 PM
Quote
The date is October 1, 2015 - the wording of the bill prohibits implementation of ICD-10 prior to that date. And it isn't official yet. The House passed the bill, but the Senate will not vote on it til Monday evening, as you previously posted. It's going to pass because it's still attached to the bill preventing reimbursement rates from falling 24% as of April 1st (the day after the vote). There isn't time to debate it. It's pretty much a foregone conclusion. It was a sneaky move, lol http://www.ihealthbeat.org/articles/2014/3/27/house-passes-doc-fix-that-includes-one-year-icd-10-delay

SNEAKY is the MIDDLE name of the Obama Administration.. funny since their campaign centered around "transparency".   Sorry I couldn't help myself. The majority of people agree with this.
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: RichardP on March 28, 2014, 03:40:05 PM
SNEAKY is the MIDDLE name of the Obama Administration..

I'm thinking it was the Republicans in the House who pushed this delay through, not the Democrats.
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: shanbull on March 28, 2014, 04:28:34 PM
SNEAKY is the MIDDLE name of the Obama Administration..

I'm thinking it was the Republicans in the House who pushed this delay through, not the Democrats.

Based on what I'm hearing, several of the major insurance companies privately freaked out about how they were not going to have infrastructure in place by the 2014 deadline. I'm sure their lobbyists were in contact with both parties. There are also plenty of doctors who wanted the delay and they also have industry lobbying groups. The bills for the House and Senate are actually different, but an identical line of text was added to both.

Edit: I also found this, which is as close to an official rationale as I've found so far:

Quote
The House bill was apparently brokered on a bipartisan basis, most likely as a concession to physicians lamenting the failure of Congress to pass a permanent repeal of the SGR formula. In February, the American Medical Association released a report claiming that implementation costs for medical groups would be greater than originally expected.
Source: http://www.advisory.com/research/financial-leadership-council/at-the-margins/2014/03/breaking-another-icd10-delay (http://www.advisory.com/research/financial-leadership-council/at-the-margins/2014/03/breaking-another-icd10-delay)
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: PMRNC on March 28, 2014, 05:10:49 PM
Quote
Is that just wishful thinking on their part, or do we have confirmation that the delay is official?

No Richard, I'm just going by past situations .. it has to go through the senate. They are OBVIOUSLY using the ICD-10 as a bargaining chip, doesn't take a rocket scientist to figure that one out.
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: PMRNC on March 31, 2014, 03:48:36 PM
http://www.c-span.org/video/?318581-1/us-senate-legislative-business

Live. Watch now.

Remember ICD-10 is only small portion of what they are voting on.   The SGR can technically WAIT till next week due to the Medicare claims hold.. so I bet they magically run out of time.

Quote
I'm thinking it was the Republicans in the House who pushed this delay through, not the Democrats.

I said SNEAKY was the middle name of the Obama Administration.   Not sure it matters if it was a Republican or Democrat.   Personally I'd rather delay then face the denials we are going to be facing. As someone who's worked at a few health insurance carries, I can assure you they were relying ONLY on computer edits. And again..they SNUCK the ICD-10 delay into the major factors like the SGR.. so it will be delayed as PART of the whole package.

Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: RichardP on March 31, 2014, 06:23:48 PM
Senate passed and sent to President for signature.

http://thehill.com/blogs/floor-action/senate/202235-senate-sends-doc-fix-to-obama
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: PMRNC on March 31, 2014, 06:31:30 PM
Yep.. praise the new band-aid. LOL

ICD-10 delayed

Mental health reform passed.

what a week and it's only Monday. LOL
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: SnyderKristine on April 01, 2014, 07:51:44 AM
This news has made my day.. Yeah I know I am little a non-patriotic this time but ICD-10 was giving me a hard time...Phewww! ::) ::) ::) ::) ::)
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: HeidiK on April 01, 2014, 08:22:58 AM
Good Morning!

Yesterday's vote was a huge disappointment for some and and the same time others a breathing a huge sigh of relief!  I was extremely happy to see so much activity and passion on both sides!  Never in my life did I think I'd enjoy watching a Senate vote on CSPAN - it was like watching the Superbowl!   ;D

The passing of H.R. 4302 represents many important issues.  Hospitals and providers will not experience a 24% pay cut, Medicare Advantage Plans for special needs individuals are extended as well as extension of the two-midnight-rule; Special Diabetes Programs; home visits for maternal, infant and early childhood home visit programs and skilled nursing facility value-based purchasing among others.  These issues affect the immediate needs of a staggering number of people and in a democracy, majority typically stands to rule.

Other issues which were included in this bill were items which have more of a long-term effect in my opinion, and do not represent quite as many people such as elimination of limitations on deductibles for employer-sponsored health plans.  This was not specifically mentioned during the debates however, I believe many people will be surprised when they choose a seemingly low-cost option not realizing they may have a $20,000+ deductible.  There was also a delay for the effective date for Medicaid amendments relating to beneficiary liability settlements which a fair number of people were counting on so they could plan to file their potential claims or not.

Obviously, I was interested in the provision which was only added to the bill two nights before the vote, delay of ICD-10.  I believed it would go forward this year because it was originally recommended in 2003 and new drafts were available for public comment every year from 2007-2014.  This delay affects so many hospitals, providers, insurance carriers, health IT workers, HIM professionals, colleges and universities who have invested billions in dollars as well as countless hours preparing.  Over 25,000 HIM graduates have only received ICD-10 training for their degree, ICD-9 was mentioned in a historical sense. 

Imagine their worry about getting a job as a new grad anyway, and now they don't even have a skill for immediate use.  IF ICD-10 goes into effect in 2015, they will require additional training to refresh their knowledge along with all the others who are already dual-coding or recently certified (including me!).

Many future population health programs currently being designed were depending on ICD-10 due to it's accuracy and specificity.  Those have all been put off indefinitely as well.

For me personally, I am disappointed.  On the other hand, there are many opportunities to really educate private practice offices and others so ICD-10 might go into effect next year.  It's not just a new coding set for reimbursement, you can follow these links if you are interested in understanding the many areas clinical data might improve healthcare overall.

Study on how clinicial data can change healthcare
http://www.ncbi.nlm.nih.gov/books/NBK54296/

Is Technological Change Worth It In Medicine?
http://m.content.healthaffairs.org/content/20/5/11.full

I made many new connections over the last few days and I have to admit, it was interesting to develop "virtual" relationships with others who shared my passion about ICD-10.  During the final hour when the vote was actually taking place, the editor of Government Health IT, Tom Sullivan and I were private messaging each other on Twitter trying to determine if President Obama could issue a line-item veto!

All in all, much more work lies ahead for all of whether it is ICD-10 related or not.  I'm just happy to be involved in healthcare during this challenging transition towards true quality care for patients.
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: PMRNC on April 01, 2014, 08:39:30 AM
Quote
This delay affects so many hospitals, providers, insurance carriers, health IT workers, HIM professionals, colleges and universities who have invested billions in dollars as well as countless hours preparing.  Over 25,000 HIM graduates have only received ICD-10 training for their degree, ICD-9 was mentioned in a historical sense.
 
 
Imagine their worry about getting a job as a new grad anyway, and now they don't even have a skill for immediate use.  IF ICD-10 goes into effect in 2015, they will require additional training to refresh their knowledge along with all the others who are already dual-coding or recently certified (including me!).

This is what I'm confused about. First I'm disappointed myself, but I never really believed it would go forward anyway based on almost every other change we've dealt with in the past.. delay is their middle name.. though now I think this administration added yet another word "OVERHAUL" in there. Anyway.. one's training, money, time is not wasted. It is never wasted. As for graduates and those NEW in the business who did not get proper ICD-9 training I do feel bad fro them on one hand but on the other hand one has to wonder what kind of teaching organizations are we seeing educate these coders?? When I first started, I was taught.. no, It was drilled through my brain.. YOU KEEP TWO YEARS worth of coding books. Why on earth wouldn't coders receive proper training on a CURRENT system and put all their eggs in the ICD-10 basket? To me that makes no sense and seems to me that's where the anger should get directed to. I also wonder how many really research this industry before getting into it. Second to banking, it's one of the most highly regulated industries around. Why weren't these educators teaching them about current coding systems to prepare them for an audit that might be done a year, two years or three years down the road? Not like we could say "OH we didn't learn ICD-9."  Even when I was a claims examiner we had access to 5 years worth of code's and edits. When I started my billing company I kept 3 years of books/references ON hand. I didn't just learn the new and forget the old. This business requires "continued" education but we also have to stay ahead by staying backward and forward.  If what your saying is true that graduates only came out with ICD-10 and ICD-9 was historically mentioned.. SHAME ON THEM and the student was duped!


Oh but how moot.. Late last night the Senate met and decided to go forward with a 10 year fix to SGR, no delay for ICD-10, mental health reform was passed. Ahhhhh I see a bottle of wine in the next 8 hours. :) :) :) 















APRIL FOOLS!   :P :P :P :P :o :o :o ;D ;D ;D
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: HeidiK on April 01, 2014, 01:43:22 PM
Hey Linda!

I agree, to a point, that training, money and time haven't been "wasted".  No one could ever take that away and as long as the knowledge gained is maintained - waste will not occur.  Many in the industry believed ICD-10 would be implemented this year - as passionately as you did that it wouldn't! 

The reality on how that training, money and time will be efficiently and productively used remains to be seen.  There are many people (employees or consultants) who are working right now on ICD-10 related issues who stand to lose their jobs with the "promise" to be re-hired or brought back in six months or so when the next deadline is announced.  Will they keep up their skills?  Will they really be brought back or will those employers find someone new? 

Hospitals were much more prepared than private practice and coders, as well as billers have been dual-coding for months now in an effort to continue reaching the same productivity levels as they do currently with ICD-9.  A typical coder must achieve a 98% accuracy rate and they are "on probation" for up to two years in order to reach that.  That accuracy rate must be carefully reviewed and maintained as it directly affects reimbursement.  Will hospitals put a "freeze" on dual coding for a period of time now that the date has been pushed out another year?  Is it fair that hospital administration must now "gamble" on the pros and cons of losing the momentum and progress made vs. backsliding and trying to start over next year - maybe?

That one simple statement included in H.R. 4302 will have unknown effects throughout the industry.  In 2012, there were over 5700 hospitals in the US with expenses totaling $829,665,386,000.  http://www.aha.org/research/rc/stat-studies/fast-facts.shtml. 

Typically, hospitals employ certified coders who maintain memberships and credentials.  The majority of AHIMA's 72,000 members work in a hospital setting and they are responsible for accurate assignment of codes so that $8 billion in expenses can be covered.  Add in all the AAPC coders and non-certified coders and you are talking about a LOT of people who have already spent countless hours going through expensive training, Not to mention the cost of coding books and software, IT restructure to allow dual coding and testing of submitted claims.  Will all of those projects now be put on hold "indefinitely" or kept up "just in case" next year it finally goes into effect? 

Keep in mind, hospital administration has been "gambling" on these types of financially related questions every year since 2007 so they have had to be prepared each year "just in case".  With all of last years momentum prior to being delayed, the belief that 2014 was finally going to be the year it happened the gamble was made to significantly increase efforts, training and money.  Especially considering how CMS (usually hospitals biggest payor) stated over and over there would be NO more delays.

As far as schools and institutions only offering ICD-10 training, you make a good point and I'm actually going to look further into it.  :)   Based on my understanding without exact details however, here again is yet another gamble to be made.  To teach both ICD-9 and ICD-10, students would have to incur higher tuition rates due to additional credit hours.  Colleges and universities must calculate the federal limits on grants and loans available to students while they coordinate all the necessary disciplines required for a degree.  Those are only two of the factors that administration must consider if they will continue to hold accreditation from CAHIIM.  http://www.cahiim.org/policiescurriculum.html  Those two factors along with everything else basically caused colleges to "gamble" and remove ICD-9 curriculum - there was really no other choice due to CAHIIM standards.

I look at it this way, CAHIIM for colleges is the equivalent to the Joint Commission for hospitals.  Just like hospitals aren't "required" to hold JCAHO accreditation, colleges aren't "required" to hold CAHIIM accreditation.  The issue is that hospitals typically hire AHIMA credentialed coders and AHIMA only offers degrees following CAHIIM accreditation standards.  So, just like hospitals wanting to accept Medicare patients, they must be accredited by JCAHO.  Same principal for CAHIIM and colleges.

So, when you consider all of the people involved in everything I briefly described above, plus all the AAPC coders/billers and everyone else I'm not mentioning here, and then calculate the actual dollar value of all the training, money and time invested by not only all those people individually but their families as well, the question "Was it wasted or not?" is a matter of opinion I guess. CMS calculated the number to be up to $6 billion last year.  So $6 billion plus interest for another year PLUS whatever it might take to get us ready for next year (maybe) is the dollar amount lost due to this delay.

Like I said above, I agree to a point because I believe education and experience can never be taken away from anyone.  Even though I could talk or write about it for hours, I don't know all the details and numbers although I also believe many would agree that understanding what I briefly wrote here might have been an important factor to consider before writing that one simple sentence into H.R. 4302 which had NOTHING to do with it.

I'd also be curious to know if the dollar amount of all the training, money and time invested in ICD-10 currently plus one more year, if it could ever actually be calculated, would be comparable to doctors getting a 24% pay cut from Medicare and Medicaid. So many people are now facing the possibility of losing a 100% pay cut and countless others will pay in additional training, money and time which may not end up being 24% but it's still important to them and keeps their families going. 

Consider it this way, if I were a doctor making $200,000. per year from Medicare, Medicaid and other Govt insurances and 24% were lost due to yesterdays bill, I'd still have $152,000 plus all the money I collect from the other carriers I contracted with as well as the self-pay patients and whatever other income I bring in.  For me personally, I would have to adjust my spending and hell yeah! $48k is a LOT!   

But look at all the people I described above who are, for arguments sake, making $50,000 per year TOTAL - no other income and no other skill.  Some may have lost their job (or opportunity for a job) completely.  If they keep their job, they will have to work harder and/or spend more time, plus continue or re-do training either at their personal expense or the providers and others who followed the rules and are ready NOW as was mandated up until yesterday.

So again, I agree with you to a point and I will continue to educate myself and others about ICD-10 and the importance of knowing what is being talked about as well as what people are getting into if they choose medical billing and/or coding.  I've always enjoyed it, always will but most importantly -  I'll always do my best to have a Plan B!
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: HeidiK on April 01, 2014, 02:11:08 PM
OMG can I go on and on and on about this!  Sorry for such lengthy posts but I have one more reply to Linda about coders and the education they received .  We often talk here about the difference between billers and coders and this is a great way to hopefully understand.  In private practice, coders and billers responsibilities are inherent to each other.  In a small practice, doctors don't typically need separate people to handle the task and so they hire one person or a medical billing service to handle the task.  Coding on the professional side is completely different than private practice.

Coders in the hospital setting are completely separate from the billers and they never work with each other.  They strictly read the documentation and code based on what is written.  Doctors hardly ever code in a hospital, they have no idea how that works on the hospital side.  A coder is trained to understand documentation and more importantly, identify when something is missing so a CDI (Clinical Documentation Improvement) specialist can go to the doctor and query him/her for what might be missing.  When I did my clinical practicum at University Hospitals, this was the biggest challenge for me because of my billing experience.  I would often turn in work with modifiers which was always returned because "the billers" took care of that.  It was extremely challenging to switch gears and get used to a different way of thinking.

For example, lab notes are reviewed when coding a chart and if there is a result showing abnormally low results of red blood cells but the doctor didn't document "anemia" anywhere, they must forward it to the CDI department and verify if the word "anemia" should be added to the discharge.  This is critical to the final DRG applied to that admission because hospitals are paid on MS-DRG rates, not on individually lined items like private practice.

Seasoned and experienced coders in hospitals are on average, 46-54 years old and have no interest in learning ICD-10 so many are receiving incentives and bonuses for learning the new code set.  Others not interested or failing to meet productivity levels during this dual-coding phase are being transitioned into a role where the focus will be on ICD-9 only. 

This is another reason schools decided to remove ICD-9 from current curriculum.  Newly graduated coders coming in have focused on coding charts with ICD-10 only for "practice" and to raise productivity rates so they were ready for October. The other coders have been required to dual-code so they can practice ICD-10 and at the same time, code in ICD-9 so the chart can go to the billers for submission.  The coders I mentioned have continued to train in ICD-10 with the intention of a full transition to ICD-9 review for anything prior later this year.

More training, money and time wasted or not?  Here again, it's a matter of personal opinion.  ;)
Title: Re: ICD-10 DELAY coming.. just like I said it would
Post by: RichardP on April 02, 2014, 02:25:20 PM
According to this link, the delay was signed on 4-1-14.

http://ehrintelligence.com/2014/04/02/how-will-cios-cmios-respond-to-the-latest-icd-10-delay/