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ICD-10 DELAY coming.. just like I said it would

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PMRNC:

--- 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!).
--- End quote ---

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

HeidiK:
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!

HeidiK:
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.  ;)

RichardP:
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/

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