Hurry up and wait
ID for plans; another year for ICD-10
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.”