Hurry up and wait

ID for plans; an­other year for ICD-10

Modern Healthcare - - THE WEEK IN HEALTHCARE - Joseph Conn

Nearly 16 years af­ter the pas­sage of the Health In­sur­ance Porta­bil­ity and Ac­count­abil­ity Act, HHS pro­posed a com­pli­ance date on a HIPAA man­date that all health in­sur­ance plans be nu­mer­i­cally tagged with a unique health plan iden­ti­fier.

In a 198-page pro­posed rule, HHS also rolled back by one year the com­pli­ance dead­line for con­ver­sion to ICD-10 di­ag­nos­tic and pro­ce­dural codes. The new pro­posed dead­line is Oct. 1, 2014.

The 2010 Pa­tient Pro­tec­tion and Af­ford­able Care Act forced the is­sue on the health plan ID, re­quir­ing HHS to pro­mul­gate an in­terim final rule for a health plan iden­ti­fier ef­fec­tive no later than Oct. 1, 2012.

The health plan ID is ex­pected to yield the most ben­e­fit for providers, while health plans will bear most of the costs. Of­fi­cials es­ti­mate the costs to com­mer­cial and gov­ern­ment health plans at be­tween $650 mil­lion and $1.3 bil­lion. The rule mak­ers es­ti­mate the plan iden­ti­fier could save providers and plans up to $4.6 bil­lion over a decade through “de­creased ad­min­is­tra­tive time spent by providers in­ter­act­ing with health plans,” and “ma­te­rial cost sav­ings through au­to­ma­tion of pro­cesses.”

While the ef­fec­tive date of the rule—when health plans can be­gin ap­ply­ing for one or more of the 10-digit iden­ti­fi­ca­tion num­bers— is pro­posed for Oct. 1, 2012, the com­pli­ance dates are Oct. 1, 2014, for most plans and Oct. 1, 2015, for smaller plans. Amer­ica’s Health In­sur­ance Plans, the in­dus­try’s main trade group, was still re­view­ing the pro­posed rule, a spokesman said, and de­clined to com­ment.

HHS Sec­re­tary Kath­leen Se­be­lius tele­graphed the post­pone­ment of the ICD-10 con­ver­sion in Fe­bru­ary in re­sponse to grow­ing in­dus­try angst about whether the 2013 dead­line was at­tain­able.

Still, some providers and pay­ers have been mov­ing to­ward ICD-10 com­pli­ance on sched­ule, so push­ing back ICD-10, ac­cord­ing to a fi­nan­cial anal­y­sis in­cluded in the pro­posed rule, will cost the en­tire health­care in­dus­try be­tween $1 bil­lion and $6.5 bil­lion, HHS said in the pro­posed rule.

The de­lay was a dis­ap­point­ment for Stephen Ste­wart, chief in­for­ma­tion of­fi­cer of the Henry County Health Cen­ter, a 25-bed crit­i­cal-ac­cess hospi­tal in Mount Pleas­ant, Iowa. “We should have just stayed the course and did it,” Ste­wart said.

His hospi­tal had al­ready trained a cou­ple of lead coders and was on track to be­gin test­ing in Septem­ber, with the goal of be­ing ready to sub­mit claims in ICD-10 with any payer who was able by the end of this year, Ste­wart said. “Prob­a­bly the big­gest dis­ap­point­ment is you work re­ally hard to build aware­ness and get a project rolling and preach to your physi­cians and you get some mo­men­tum, and then you get the wheels kicked out from un­der you.”

Even with the de­lay, Ste­wart said, the process won’t be easy. “As we go fur­ther, we run into things that in­crease the scope of the project,” he said. “For peo­ple who haven’t even started yet, they re­ally don’t have an idea of what’s in front of them. My ad­vice to any­one is, yes, an ad­di­tional year gives you more time, but don’t sit back.”

Jen­nifer Sch­le­man, spokes­woman for the Amer­i­can Hospi­tal As­so­ci­a­tion, which has been sup­port­ive of ICD-10, said in an e- mailed state­ment that this week’s an­nounce­ment “is wel­come news, es­pe­cially for smaller hos­pi­tals.” She added that the as­so­ci­a­tion is “also pleased at the in­clu­sion of unique health plan iden­ti­fiers, which will fur­ther stream­line the billing process.”

Robert Ten­nant, gov­ern­ment af­fairs se­nior pol­icy ad­viser for the MGMA, said his or­ga­ni­za­tion is “pleased with the ad­di­tional time for ICD-10,” but it has called for HHS to im­prove the “flawed process” of im­ple­ment­ing the con­ver­sion. First, Ten­nant said HHS needs to be “more ag­gres­sive on cer­ti­fi­ca­tion” of IT sys­tems and press for a vol­un­tary sys­tem of cer­ti­fi­ca­tion of prac­tice man­age­ment sys­tems as be­ing ICD10 com­pli­ant. He also said HHS should stage the roll­out with com­pli­ance deadlines for claims clear­ing­houses and health plans com­ing first, a year ahead of the dead­line for providers, and that HHS should spon­sor pi­lot test­ing.

The Amer­i­can Med­i­cal As­so­ci­a­tion, which has pre­vi­ously called for HHS to scrap the im­ple­men­ta­tion of ICD-10 al­to­gether, re­sponded in a state­ment by its pres­i­dent, Dr. Peter Carmel, that it was still cool to the code-set up­date, but warmer to the plan ID dead­line. He called the post­pone­ment “the first of many steps that reg­u­la­tors need to take to re­duce the num­ber of costly, time­con­sum­ing reg­u­la­tory bur­dens that physi­cians are shoul­der­ing.”

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