Pay cuts and ICD-10 Updates

The last month has seen some more sitting around by the government, whether it is for good or ill will take time to tell.  Two big issues were touched: the Medicare pay cuts and ICD-10.  To say they were addressed would be a misnomer. 
The Medicare pay cuts were stalled though the end of the year (2012), but a permanent solution has yet to be released.  It is very convenient that in this election year things keep getting put off until after the elections.  Whoever walks into this mess at the end of the year will have to see if they have the know-how and the power to get things resolved, or if they will continue to pass along so many of these issues.

The ICD-10 changeover has been in progress for a few years now and was already put off a couple of years until October of 2013.  The AMA and others have been lobbying to get it pushed back even farther stating that it puts an undue burden on physicians to do it.  Well, they have succeeded, last month Secretary of Health & Human Services, Kathleen Sebelius, officially announced that the HHS “intends to delay” the ICD-10 implementation.  The funny part is the government really got things going.  They got meaningful use (aka the Stimulus Plan) up and running and showing payouts at this point.  5010 is up and hobbling, but still up.  It’s been unusually tenacious and dogged of them.  They’ve gotten these items in and pushed through with an almost single minded-ness and these were all steps leading up to ICD-10.  At this point there is no official implementation date for ICD-10.  They could suddenly come back and say… “we want you up and into ICD-10 by the end of 2013” or they could put it off for another year, or two, or really freak people out and wait for ICD-11.

ICD-10 Update to the Update... A new ICD-10 implementation date was released in April. The date has been bumped one full year to October 1, 2014.
 
Many are the reports that are saying that as costly as the ICD-10 changeover is, at this point it will probably be more costly to more people to delay.  From a standpoint of those who have been steadily preparing for and working for a smooth ICD-10 transition and will now be stalled and dragged out with no clear resolution in site, this will be a continued and continuing cost burden.  For those who have been waiting for more solid information to make and execute plans, this delay with no action or date, will continue to add to the mounting stress of the continued unknown.  For the procrastinators, they think they have won the day, but from all the government has pushed through and accomplished this is still an inevitable changeover (probably worse if they do end up choosing to wait for ICD-11).

What the shortsighted don’t see is that whether there is much of a wait for ICD-10 or not, ICD-10 isn’t really the problem.  The problem is a current and ongoing one:  too many offices don’t have the proper documentation to back up their diagnoses, ICD-10 won’t honestly make or break this, it will just place a bigger spotlight on it.  ICD-10 isn’t the enemy, weak documentation is.  With NPI, meaningful use, and 5010 already in place, any and all bad or sub-par documentation is already starting to glow brightly.  Insurance companies are not reimbursing as quickly or as easily and audits in every area of healthcare are rising, especially where federal or state funds cross paths with it.  The other thing the ICD-10 delay does is give insurance companies a big break.  They can continue to pay good providers, with good documentation, the cheaper reimbursement rates.  Without the more detailed codes letting them know how much some providers are really doing, and showing that difference, they can continue pay good providers poorly, because they don’t/can’t “see” the difference in the services being provided.

As always, good documentation doesn’t have a date – for expiration or beginning.  Conduct self-audits, make sure your current documentation supports your current codes, and then stretch a little,  start upping your staff training  and make sure that they are current and up-to-date (doctors, you too!).  The better trained you and your staff are, the more current and up-to-date you are, the more you care now, the less you will have to care about future change, because you will be ready having already changed along the way.  Start today, don’t delay, updated training, good documentation, and proper billing will pay dividends now and in the future, whenever and whatever is decided.