While I didn’t intend for the theme of my Health Care Law Today posts to be delays, there is no shortage of postponements to write about lately. The House and Senate passed H.R. 4302, Protecting Access to Medicare Act of 2014, which delays ICD-10 implementation until October 1, 2015. The main purpose of the bill is to provide a temporary fix to the Medicare sustainable growth rate (SGR), but a small portion of the bill delays the adoption of ICD-10 codes for at least another year. 

Providers, consultants, vendors, and health lawyers have been preparing for the ICD-10 transition since 2009 when the U.S. Department of Health & Human Services (HHS) published a final rule establishing ICD-10 as the new national coding standard effective October 1, 2013. (Arguably, the United States has been preparing for the transition since the World Health Organization (WHO) published the ICD-10 coding system in 1992. Other countries such as Australia and Canada have been using ICD-10 since 1998 and 2000, respectively.) October 1, 2013 became October 1, 2014 when the Centers for Medicare & Medicaid Services (CMS) issued final rule CMS-0030-F on August 24, 2012. Government officials publicly stated at conferences such as Healthcare Information and Management Systems Society (HIMSS) that there would be no delay past October 1, 2014, but the inclusion of the ICD-10 delay in the SGR bill has brought us to 2015.

According to CMS, the adoption of the ICD-10 code sets is expected to:

  • Support value-based purchasing and Medicare’s anti-fraud and abuse activities by accurately defining services and providing specific diagnosis and treatment information;
  • Support comprehensive reporting of quality data;
  • Ensure more accurate payments for new procedures, fewer rejected claims, improved disease management, and harmonization of disease monitoring and reporting worldwide; and
  • Allow the United States to compare its data with international data to track the incidence and spread of disease and treatment outcomes because the United States is one of the few developed countries not using ICD-10.

Beyond deferring the expected benefits of transitioning to ICD-10, CMS states that the postponement till 2015 creates an estimated $1 billion to $6.6 billion in industry costs, and it creates logistical challenges for many entities who have been preparing for the 2014 deadline. However, there are many providers welcoming the additional time to prepare and designate resources for the complicated and burdensome transition. 

CMS will need to provide guidance on the revised implementation deadline and whether materials such as the Crosswalks for Local Coverage Determinations (LCDs) or the pilot version of the October 2013 Integrated Outpatient Code Editor will still be issued in April and August 2014 as planned.