Can CMS delay enforcement of ICD-10 compliance?

Carl Natale
by Carl Natale

The Centers for Medicare and Medicaid Services (CMS) won't budge on the ICD-10 implementation deadline. They insist the federal government will be ready and healthcare organizations need to be ready.

But that doesn't stop a healthcare professional from dreaming. No, I'm not talking about the American Medical Association's (AMA) vigorous opposition to ICD-10 implementation.

I'm referring to John D. Halamka, chief information officer of Beth Israel Deaconess Medical Center, who doesn't think enough healthcare organizations will be ready for ICD-10 implementation on Oct. 1. He's worried about:

  • Meaningful Use stage 2 attestation
  • ICD-10 implementation
  • HIPAA Omnibus Rule readiness
  • Accountable Care Act (ACA) implementation

He contends all these initiatives are creating too many problems for the healthcare industry to handle properly. Considering all the bad press the ACA is getting right now, not many people will argue with Halamka.

He wants a six-month enforcement delay of on ICD-10 compliance so healthcare providers and payers who are ready can go live.

"ICD-10 enforcement deadlines should be extended by 6 months to enable additional testing and workflow redesign.  The October 1, 2014 deadline may work for some providers and payers. Transaction flow can begin if systems are functional.   However, a 6 month extension will enable providers and payers to revise and improve systems before a mandatory full cutover.   We need to do this to avoid another healthcare.gov situation."

Sounds Solomon like. (Is there an ICD-10 code for splitting the baby down the middle?)

[ICD10Watch Poll: Should CMS delay enforcement of ICD-10 compliance?]

But it may not be as simple as Halamka sees it. On the LinkedIn Group ICD-10 News, Views and Education, the idea got some push back. For example, Stanley Nachimson, Health IT Implementation Expert, doesn't consider an enforcement delay being a solution:

"Delays do little to increase the likelihood of compliance. We've already had a one year delay of the compliance date, which generally caused entities to ignore ICD-10 for a year. And a 'mixed' implementation of ICD-10 is burdensome for both plans and providers. Are providers supposed to code both 9 and 10, and then figure which one to send to each plan? And what about coordination of benefits? It is generally agreed that the industry needs to move together on ICD-10. A single date much be set and enforced."

Let's take a look at the point about "mixed implementation" of ICD-10 and ICD-9 coding. When CMS considered the last delay, healthcare payers were worried about this. They considered the prospect to be too burdensome. Systems will have to be changed again to accept both code sets.

Also consider Nachimson's point about the likelihood of ICD-10 compliance. I found some agreement in the ICD10 Watch LinkedIn Group. Joe Nichols MD, Principal - Health Data Consulting, isn't a fan:

"Historically we have continued to push back the date for implementation of ICD-10 repeatedly. Each time the date has been pushed back, providers and others in the industry have stopped work on ICD-10 rather than use that time to move forward. Their is no evidence at this point that any additional time will move anyone towards readiness; to the contrary there is lots of evidence that delays result in a negative impact on moving the industry to prepare. We have had plenty of time to prepare for this. It's time to join the rest of the world and move off of a 30 year old national standard for patient conditions."

But the reaction isn't totally against Halamka. Ellen Arnold, RHIA, ICD-10 Consultant at Provisions Group, commented in the ICD-10 News, Views and Education LinkedIn Group that she sees how this can go very wrong"

"As much as I hate to continue to deal with delays of ICD-10 from what I have seen as a consultant it would be a huge mistake to try to go live October 1, 2013. The payers are not ready, even CMS, which places a very unfair burden on already overburdened providers who are scrambling to get everything in place. Vendors have differing timelines, interfaces have to be reconfigured in almost every case, end to end testing has become problematic due to lack of cooperation by the major payers, and already overburdened (and underpaid) coders have to scramble to learn a much more complex system while continuing to maintain a heavy workload. In addition, payers have not been forthcoming about new (and more) billing edits that will be required with ICD-10. Due to all the competing initiatives (Meaningful Use, etc.) we have one of the biggest changes ever to happen to healthcare and an industry that is woefully unprepared in every way. Add resistance to even learning about the classification at every turn and it is a recipe for disaster."

"Recipe for disaster" may be a bit of hyperbole but it won't be hard to find people who believe it. The problem is that the enforcement delay could be another recipe for disaster.

But that doesn't matter. The ACA problems have created a credibility problem for CMS. They may be forced to implement a fix for the ICD-10 problem even though it may not be a problem. Especially since reasonable voices are saying there will be a problem.

An enforcement delay may be enough to acknowledge a problem that may not exist and keep ICD-10 implementation on the calendar.