The Department of Health and Human Services issued a statement announcing its intent to push back the October 1, 2013, compliance deadline for ICD-10.

News Release from HHS:

HHS announces intent to delay ICD-10 compliance date

As part of President Obama’s commitment to reducing regulatory burden, Health and Human Services Secretary Kathleen G. Sebelius today announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).

The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013 – a delay of two years from the compliance date initially specified in the 2008 proposed rule. HHS will announce a new compliance date moving forward.

“ICD-10 codes are important to many positive improvements in our health care system,” said HHS Secretary Kathleen Sebelius. “We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead. We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.”

ICD-10 codes provide more robust and specific data that will help improve patient care and enable the exchange of our health care data with that of the rest of the world that has long been using ICD-10. Entities covered under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will be required to use the ICD-10 diagnostic and procedure codes.

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December 23, 2011: The Sustained Growth Rate (SGR) cut for 2012 has been postponed!  The House of Representatives voted to continue the 2011 Conversion Factor for the Medicare Physician Fee Schedule until March 1, 2012.  Congress will have until February 29, 2012 to determine the next “fix”. 

There continues to be disagreement with the House and Senate to “fix” the SGR cut. However, they have come to an agreement to postpone the cut! (but have yet to agree on the length of the postponement)

Centers for Medicare and Medicaid Services (CMS) released the following statement on December 19, 2011: 

The negative update under current law for the 2012 Medicare Physician Fee Schedule is scheduled to take effect on Sun Jan 1, 2012, eight business days from today. Consequently, as on numerous occasions in the past, CMS will instruct its Medicare claims administration contractors to hold claims containing 2012 services paid under the Medicare Physician Fee Schedule for the first 10 business days of January 2012 (i.e., Sun Jan 1 through Tue Jan 17). The hold should have minimal impact on provider cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.

Medicare Physician Fee Schedule claims for services rendered on or before Sat Dec 31 are unaffected by the 2012 claims hold and will be processed and paid under normal procedures and time frames.

CMS will notify you on or before Wed Jan 11, 2012, with more information about the status of Congressional action to avert the negative update and next steps regarding the claims hold.

December 13, 2011, House of Representatives passed a bill, H.R. 3630 that would “fix” the SGR problem for 2 years.

Under H.R. 3630, instead of a 27.4% cut in the Medicare Physician Fee Schedule Conversion Factor (CF) due to the SGR, there would be a 1% increase in the Medicare Conversion on January 1, 2012.  In addition, the bill would authorize another 1% increase in the CF on January 1, 2013.  If Congress fails to fix the SGR between now and the end of 2013, the SGR formula would mandate a cut in the CF in excess of 30% on January 1, 2014.  HBMA stated that it is “highly unlikely that the U.S. Senate will join the House in passing H.R. 3630″, and we are all encouraged to contact our Representatives and Senators to fix the SGR problem.

Luckily, if you are not yet ready, you have an additional 90 days to become 5010 compliant!

November 17, 2011, Centers for Medicare & Medicaid Services (CMS) announced that enforcement action will not be taken until March 31, 2012. However, CMS’ Office of E-Health Standards and Services (OESS) will be accepting complaints during this 90-day enforcement discretion. If any filed-against entities are called upon by OESS, they will be responsible to provide evidence of compliancy or proof of effort to become compliant during this 90-day period.

The transition to Version 5010 will prepare your systems for the ICD-10 implementation:

-Increases the field size for codes from 5 bytes to 7 bytes

-Adds a one-digit version indicator to identify Version 9 from Version 10

-Increases the number of diagnosis codes allowed

-Includes additional data modification in the standards adopted by Medicare Fee for Service (FFS).

ICD-10 implementation is October 1, 2013.

The new coding system will contain 70,000 codes in comparison to the present 14,000 codes currently utilized. In addition to the increased amount of codes, the ICD-10 codes are up to seven (7) characters in length and include extensive descriptors for specificity.

Visit the CMS ICD-10 website for additional information and resources to ensure your practice is ready.

Did you already submit your hardship for implementing electronic health records (EHRs)?  The 15-digit certification number you entered might be incorrect!  Please note: This problem only affects the EHR hardship exemption.

September 30, 2011, Centers for Medicare and Medicaid Services (CMS) fixed the certification number field on their web page to submit EHR hardship exemptions.  The field previously only allowed thirteen (13) digits for you to enter your 15-digit certification number.  For the providers that noticed the error, CMS accepted their 15-digit code entered into the “justification for hardship exemption” field.  If you cannot recall where you entered your certification number, confirm with the QualityNet Help Desk at 1-866-288-8912 or send them an email at qnetsupport@sdps.org. 

Haven’t submitted your exemption yet?  You have until November 1, 2011 to submit your exemptions online.  The 1% eRx payment penalty starts on January 1, 2012.

For more information on the Electronic Prescribing (eRx) Incentive Program, visit the CMS website.

The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule that enables patients to electronically access their laboratory test result reports directly from labs.  This rule would amend the Clinical Laboratory Improvement Amendments (CLIA) of 1988 regulations and the Health Insurance Portability and Accountability Act (HIPAA) of 1996.  Currently, CLIA complies with state law governing whether patients can access their laboratory test results directly from the laboratory and HIPAA provides an exception to patients’ rights to access their information where a state law prohibits disclosure.

According to CMS, thirty-nine (39) states and territories prohibit the laboratory from providing direct reports to patients.  The proposed rule would require a HIPAA-covered lab to provide access in the electronic form and format requested by the individual.  If access is not provided, the report must be available in an electronic form and format as agreed to by the covered individual.  The rule would also allow laboratories to charge fees reflecting the labor costs for creating an electronic copy of the information and supplies.

The 60-day comment period for this proposed rule ends November 14, 2011.  Visit the Regulations.gov website to submit your comments online, and learn more about the proposed CLIA Program and HIPAA Privacy Rule at the Federal Registrar.