Senate Passes ICD-10 Delay Bill | Journal of AHIMA

The Senate voted today to approve a bill that will delay the implementation of ICD-10-CM/PCS by at least one year. The bill now moves to President Obama, who is expected to sign it into law. The bill was passed 64-35 at 6:59 pm ET on Monday, March 31.

463105901The bill, H.R. 4302, Protecting Access to Medicare Act of 2014, mainly creates a temporary “fix” to the Medicare sustainable growth rate (SGR). A seven-line section of the bill states that the Department of Health and Human Services (HHS) cannot adopt the ICD–10 code set as the standard until at least October 1, 2015. The healthcare industry had been preparing to switch to the ICD-10 code set on October 1, 2014.

In a statement on the Senate vote, AHIMA officials said they will work to clarify outstanding questions raised by the delay and continue to work with government officials to implement ICD-10.

“On behalf of our more than 72,000 members who have prepared for ICD-10 in good faith, AHIMA will seek immediate clarification on a number of technical issues such as the exact length of the delay,” said AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA. “AHIMA will continue our work with various public sector organizations and agencies such as the Centers for Medicare and Medicaid Services (CMS), the Office of the National Coordinator for Health IT, and the National Center for Health Statistics (NCHS) along with our industry partners such as the ICD-10 Coalition so that ICD-10 will realize its full potential to improve patient care and reduce costs. These are goals that AHIMA and other healthcare stakeholders and our government leaders all share.”

Since the transition to ICD-10 “remains inevitable and time-sensitive because of the potential risk to public health and the need to track, identify, and analyze new clinical services and treatments available for patients,” AHIMA said in a statement the organization will continue to lend technical assistance and training to stakeholders as they are forced to navigate the challenge of preparing for ICD-10 while still using ICD-9.

Thousands of AHIMA members and ICD-10 proponents contacted their congressional representatives and senators over the last week asking them to vote against the SGR bill and not delay ICD-10.

Congress Working Against SGR ‘Fix’ Deadline

Congress was working against a deadline of today, March 31, to reform or “fix” the SGR before it directly impacted physician payment. Without a fix to the SGR formula, Medicare physicians faced a 24 percent reimbursement cut beginning April 1. H.R. 4302, introduced by House Representative Joseph Pitts (R-PA), will replace the reimbursement cut with a 0.5 percent payment update through the end of 2014 and a zero percent payment update from January 1, 2015 to March 31, 2015.

Physician groups, including the American Medical Association and a coalition of nearly 90 state and national medical societies, have come out against H.R. 4302 since it does not provide a long-term solution to the SGR issue. The insertion of the ICD-10 delay section into H.R. 4302 was likely done to placate physicians who are against an SGR patch. The AMA has said they are against moving to ICD-10 entirely.

The original House bill was negotiated at the senior leadership level and quickly pushed through the House on March 27 via a voice vote, where no roll call was taken, no votes were tallied, and with the majority of representatives still out on a previously called recess.

“There’s no integrity in what we’re getting ready to vote on,” remarked Senator Tom Coburn (R-OK) as he spoke against passage of the bill despite the pressing deadline. Drawing a comparison with the principles of medicine that you don’t treat symptoms but instead treat the disease, Coburn also noted that the continued passage of SGR patches represents a corruptible process that hides truth from the consumer and demonstrates a lack of transparency from Congress. Coburn also displayed a poster that he said characterized Congress’s current methods during his speech that read “Put Off Until Tomorrow What You Should Be Doing Today.”

On Monday Senate Finance Chairman Ron Wyden (D-OR) did introduce a new SGR bill, S. 2157, that did not include the ICD-10 delay provision and would have addressed not just a “fix” for SGR but wider reform. However, Sen. Jeff Sessions (R-AL) objected to voting on S. 2157 and instead proposed the Senate vote on S. 2122, a SGR reform bill introduced on March 12 and sponsored by Sen. Orrin Hatch (R-UT) that would also repeal the individual insurance mandate of the Accountable Care Act. This vote was also objected to by senators, who in the end voted on H.R. 4302 which put off larger SGR reform to the future and delayed ICD-10 for at least one year. This legislation will become the 17th patch of the SGR since 1997.

This is the second time ICD-10 implementation has been delayed. The original compliance date of October 1, 2013 was officially pushed back a year on September 5, 2012 by CMS, who noted in their ICD-10 delay final rule that “some provider groups have expressed strong concern about their ability to meet the October 1, 2013 compliance date and the serious claims payment issues that might ensue if they do not meet the date.”

But this recent legislative call for a delay likely came as a surprise to CMS. On February 27 CMS Administrator Marilyn Tavenner announced at the Health Information and Management Systems Society Annual Conference that ICD-10 would not be delayed any further, stating “we have already delayed the adoption standard, a standard the rest of the world has adopted many years ago, and we have delayed it several times, most recently last year. There will be no change in the deadline for ICD-10.”

Impact of Delay Wide Reaching, Next Steps Unclear

The impending delay of ICD-10 raises a vast slate of questions for coding professionals, provider administrators, education entities, and even the federal government. The focus will likely turn to CMS, who will need to provide the healthcare industry guidance on the exact new implementation deadline and how to move forward.

The delay of ICD-10 impacts much more than just coded medical bills, but also quality, population health, and other programs that expected to start using ICD-10 codes in October. The extent of the logistical challenges and costs associated with “dialing back” to ICD-9-CM are not yet fully understood, AHIMA officials said, but are expected to be extensive.

CMS has estimated that another one-year delay of ICD-10 would likely cost the industry an additional $1 billion to $6.6 billion on top of the costs already incurred from the previous one-year delay.  This does not include the lost opportunity costs of failing to move to a more effective code set, AHIMA said.

Many coding education programs had switched to teaching only ICD-10 codes to students, hospitals and physician offices had begun moving into the final stages of costly and comprehensive transitions to the new code set—even the CMS and NCHS committee responsible for officially updating the current code set changed the group’s name to the ICD-10-CM/PCS Coordination and Maintenance Committee.

The delay directly impacts at least 25,000 students who have learned to code exclusively in ICD-10 in health information management (HIM) associate and baccalaureate educational programs, AHIMA said in a statement.

The United States remains one of the only developed countries that has not made the transition to ICD-10 or a clinical modification. ICD-10 proponents have called the new code set a more modern, robust, and precise coding system that is essential to fully realizing the benefits of recent investments in electronic health records and maximizing health information exchange.

While today’s vote delayed ICD-10 implementation, AHIMA officials said they will continue working to ensure that another delay does not occur legislatively. Over the upcoming weeks, updates will be added to AHIMA’s Advocacy Assistant with instructions on how members can continue to advocate their members of Congress on behalf of ICD-10.

“As demands for quality healthcare data continue to increase, this delay will add an additional significant hurdle for the healthcare system to fill these important HIM positions,” Thomas Gordon said. “It is truly unfortunate that Congress chose to embed language about delaying ICD-10 into legislation intended to address the need for an SGR fix in their effort to temporarily address the long outstanding and critically important physician payment issues.”




PrimeSource Healthcare | Medical Coder, Entry Level [Buffalo Grove …

Think innovation. Think success. Think PrimeSource Healthcare, a leading provider of on-site, mobile healthcare. Each day, more patients are choosing PrimeSource Healthcare for compassionate, personalized and supportive care in audiology, dentistry, optometry and podiatry.We are growing rapidly and need a Medical Coder to join our team.

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Preliminary Stage 3 Meaningful Use Recommendations Released …

Preliminary recommendations for stage 3 of the “meaningful use” EHR Incentive Program were released Tuesday by an Office of the National Coordinator for Health IT (ONC) workgroup.

The recommendations were presented by the Meaningful Use Workgroup during a meeting of the ONC Health IT Policy Committee, who reviewed and approved the recommendations, marking an important step toward the development of a final stage 3 rule.


163751742Updates to Stage 2 Measures Recommended

The majority of the stage 3 measure recommendations are updates to objectives included in stage 2 meaningful use, with some enhanced with more difficult provisions in order to increase the expected benefit to healthcare improvement that comes with meeting the measures.

For example, currently in stage 2 meaningful use eligible professionals must give at least 50 percent of their patients the ability to view online, download, and transmit their health information within four business days of the information becoming available to the provider. Hospitals are required to provide access to 50 percent of patients within 36 hours of discharge. Both providers need to ensure more than five percent of patients actually view their records.

In the stage 3 recommendations, both eligible professionals and hospitals would only have 24 hours to give at least a majority of their patients the ability to view online, download, and transmit their health information—if that information was generated during the course of their visit. Labs and other types of information not generated during the course of the visit would need to be available within four business days. The workgroup recommended that the requirement for patients to actually view their information be removed in stage 3.

Also, the current stage 2 measure to record patient demographics in the medical record for more than 80 percent of unique patients seen during the reporting period has been enhanced. In stage 2, eligible hospitals must have an EHR that can record the preferred language, sex, race, ethnicity, date of birth, and date and preliminary cause of death in the event of mortality.

The stage 3 recommendations call for hospital EHRs to record this data as well as record:

  • A patient’s preferred method of communication (i.e., e-mail, telephone, letter)
  • Occupation and industry codes
  • Sexual orientation or gender identity
  • Disability status


New Measures Recommended

Several new measures were added to the recommended slate as well. One new measure, if inserted into the stage 3 meaningful use final rule, would have vast implications for health information management (HIM) professionals and their oversight of the medical record.

A new recommended menu item states that eligible professionals and hospitals must receive provider-requested, electronically submitted patient-generated health information through either structured questionnaires—such as screening questionnaires, medication adherence surveys, and intake forms—or secure messaging. The method of entering the information into the EHR would be at the discretion of the provider. Patient-generated information provided through mobile devices would also count toward the measure.

Currently many HIM professionals have debated the best way to safely integrate patient-generated information into their health record, while physicians have debated over whether or not they can trust such data as reliable.

Another new measure that has HIM implications is a proposed menu measure that calls on hospitals to send electronic notifications of significant healthcare events to a patient’s care team—such as their primary care provider, referring provider, or care coordinator—within four hours of the event. Significant events that would trigger a notification include:

  • Arrival at an emergency department
  • Admission to a hospital
  • Discharge from an emergency department or hospital
  • Death


Stage 3 Next Steps

The recommendations from the workgroup are just a first step before stage 3 is finalized. With the Health IT Policy Committee approving the recommendations March 11, it is expected that ONC and the Department of Health and Human Services (HHS) will issue a stage 3 meaningful use proposed rule in the fall. After collecting public comments on the proposed rule, ONC/HHS is expected to issue a final rule in early 2015. Stage 3 is currently slated to begin in 2017.

Before the final rule is determined, ONC will likely receive many comments from the public and adjust the recommendations of the workgroup, which has occurred in the past with both stages 1 and 2 of the program.

The public comments have already begun. On February 21, 24 members of the US House of Representatives sent a letter to ONC head Karen DeSalvo and Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner asking her to use the stage 3 meaningful use criteria to address a number of healthcare issues, including a call to reduce health disparities and embrace mobile health platforms. While ONC develops the meaningful use measures, CMS operates the program and issues incentive payments.

View the full stage 3 recommendations of the Health IT Policy Committee’s Meaningful Use Workgroup here.




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    CMS Announces Limited ICD-10 Claims Testing | Journal of AHIMA

    187030633News that the Centers for Medicare and Medicaid Services (CMS) will offer a rigorous, four-pronged approached to ICD-10-CM/PCS (ICD-10) preparedness and claims testing for fee-for-service providers was welcomed by panelists at a federal health subcommittee hearing Wednesday.

    At a hearing held by the National Committee on Vital Health Statistics Subcommittee on Standards (NCVHS), an advisory body to the US Department of Health and Human Services subcommittee, CMS officials said the agency would begin end-to-end test claims with ICD-10 codes starting this summer for a small sample group of providers.

    The testing will include submission of test claims to CMS with ICD-10 codes and the provider’s receipt of a Remittance Advice (RA) that explains the adjudication of the claims. The sample will include a cross-section of provider types, claims types, and submitter types, according to the CMS newsletter MLN Matters.

    The other three components to CMS’s readiness plan includes CMS internal testing of its claim processing systems, provider-initiated beta testing tools, and acknowledgement testing.


    ICD-10-CM/PCS Readiness a Mixed Bag

    Hearing panelists, which included Meryl Bloomrosen, MBA, RHIA, FAHIMA, AHIMA’s vice president of thought leadership, practice excellence, and public policy, and representatives from the American Medical Association (AMA), the American Hospital Association (AHA), Humana, Emdeon, and others, applauded the news, noting that stakeholder groups have been calling on CMS to offer such testing for quite some time.

    The hearing, titled “ICD-10: Achieving a Successful Transition,” addressed lingering industry concerns about ICD-10 implementation and readiness, as well as private and public solutions for preparation.

    While panelists on the provider and the payer side expressed a mix of optimism and concern, panelists and CMS officials agreed that the October 1, 2014 deadline must not—and would not be moved.

    George Arges, senior director, AHA, urged “the entire community to stop debating ICD-10 and take action to support implementation,” noting that a recent AHA study found that the vast majority of hospitals will be ready for the transition.

    Bloomrosen said she welcomed CMS’s end-to-end testing program and made note of the AHA’s readiness study, adding, “In terms of studies, I’m not sure there’s agreement on what readiness means. There’s a gut feeling that we’ll know it when we see it,” Bloomrosen said.

    She also added that ICD-10 transition challenges AHIMA has identified include areas such as coder education, clinician education, workforce shortages, and clinical documentation improvement training.

    In a written statement submitted with her testimony Bloomrosen said, “EHR [electronic health record] and CAC [computer assisted coding] technologies can be leveraged to automate and improve documentation, coding, data extraction, and ultimately patient care. The effective use of technology as well as other risk mitigation strategies I mentioned earlier will help to ensure that healthcare organizations transition to ICD-10 smoothly, with minimal disruption, and realize the benefits of better healthcare data earlier.”


    AMA Resistance to ICD-10-CM/PCS Continues

    The American Medical Association, however, has not tamped down its efforts to delay or block ICD-10 implementation. Nancy Spector, the AMA’s director, electronic medical systems, touted a new AMA-sponsored study at the hearing. The study found the costs for the ICD-10 transition will be higher than previous estimates for physician practices.

    The cost study compared expected implementation costs from 2008 with those anticipated today. New cost estimates for small physician practices range from $56,639 to $226,105, compared to $83,290 in 2008. Current estimates for large practices range from $2 million to $8 million compared to $2.7 million in 2008, according to the Nachimson Advisors report. The report authors admit that the 2008 estimates were derived prior to the American Reinvestment and Recovery Act (ARRA) of 2009’s financial stimulus to the health IT industry, and “that no actual implementation experience existed” in 2008.

    In a letter urging US Health and Human Service Secretary Kathleen Sebelius to reconsider adoption of the ICD-10-CM/PCS code set, the AMA wrote that “Physicians are being asked to assume this burdensome requirement at the same time they are being required to adopt new technology, re-engineer workflow and reform the way they deliver care; all of which are interfering with their ability to care for patients and make investments to improve quality.” The AMA also launched a Twitter campaign encouraging members to Tweet against ICD-10 using the hashtag #StopICD10.

    Other healthcare stakeholders are forging ahead with implementation plans and testing. The Massachusetts Health Data Consortium, for example, brings together health plans, providers, vendors, government entities, and IT groups to develop an ICD-10 testing solution that can be tested across the state, according to Medical Practice Insider.

    Additionally, the Workgroup for Electronic Data Interchange (WEDI) is working with the Centers for Medicare and Medicaid Services, as well as other private and public partners, including AHIMA, on an ICD-10 Implementation Success Initiative. In addition to creating a searchable database of ICD-10 issues and concerns, the initiative “will help triage issues and provide valuable information and resources to help healthcare organizations understand how the new codes and coding standards will impact diagnosis and inpatient procedures.”




    Coding Consultant – Jobs Careers Employment Hiring | Healthcare …

    Coding Consultant, Utica Park Clinic

    Utica Park Clinic is the physicians group of Hillcrest HealthCare System. With over 35 locations throughout northeastern Oklahoma, most patients enjoy the convenience of a location that is close to home. UPC patients have consistently given top ratings (98% patient satisfaction scores) for the quality of care they receive.  When choosing a healthcare provider, you can be confident that you’ll find a good match at Utica Park Clinic.

    The Coding Consultant works with multi-specialty physicians providing education and support. This individual must be able to code from medical records and be able to perform and document coding audits, as well as execute results back to the physicians and administration. This position will adhere to all policies, procedures and regulations to ensure patient safety and compliance. Need someone with 3-5 years experience in ICD-9 CM, CPT-4, HCPCS, evaluation and management coding, multi-specialty experience preferred.

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    How to Choose an Online Training Program | Army Wife Network

    Online education is here to stay. It’s a great option whether you’re looking for something that lets you go back to school while juggling a family or work schedule, you just don’t want to deal with the hassle of transferring if you move, or you want to be able to learn at the pace that works best for you. Even long-established colleges and universities now have online programs—but with all the online training options, how do you choose? What are the signs that a program will be worth your time and money.

    Well, I happen to have the inside scoop on that story. Let me give you the low down.

    There are two areas to consider when you’re comparing online programs: quality and support. Just like all college programs aren’t created equal, there can be huge differences in the training you get from different online courses. You want to choose a program that will leave you prepared to actually get a job. It’s also easy to feel like you’re all alone when you’re training online; it’s a lot easier to get through a training program when you feel well supported with the help you need.

    So, with that in mind, here are a few questions to guide your online program selection…

    Is this program approved by reputable industry organizations?

    A school’s accreditation tells you that a third party organization has verified that the school offers quality training overall—there’s no guarantee that that third party actually looked at the program your considering or that they have the expertise to judge the quality of that training if they did. However, if a program is approved by the leading industry organization, you have the reassurance that people who actually do the job you’re training for believe that the training program will prepare you to be successful.

    Let me make this a little more concrete with an example from our catalog. Medical coding and billing is a very detail-oriented, complicated field, and there’s no guarantee that someone from a third party accreditation organization would know enough about the ins and outs of coding to truly judge the quality of our program. On the other hand, the American Health Information Management Association (AHIMA) is the largest industry association for medical coders in the country. They offer a number of credentials that certify coders’ skills and expertise, and their name is recognized by every employer in the country. Career Step’s Professional Medical Coding and Billing program is one of the only online training programs approved by AHIMA, and our course went through an extensive evaluation process involving an entire panel of reviewers to earn that approval. That’s a stamp of approval that actually carries weight because employers have a third party they trust telling them that our graduates have the skills to do the job.

    What resources are available when I need help?

    The resources that come with an online training program can vary from being completely on your own to being required to participate in instructor chats or post a certain number of times in a student forum. Obviously, everyone is comfortable with different levels of support, but a course that at the very least has instructors available to help when you need it can be a good marker of program quality. You should also ask if the instructors have real world experience working in the field you’re preparing for. Who better to help you train for a new job than someone who’s actually done it?

    Do graduates get jobs, and what support is available after graduation?

    At the end of the day it all comes down to whether you’ll be able to get a good job when you’re done. So ask the question, and do your research. See if you can actually talk to others who have taken the course and ask what their experiences were—both in the job market and with any available graduate support resources. If you’re training for a career field you have no experience in (for example, if you’ve only ever worked in retail and you’re preparing for a career in healthcare), having graduate support advisors who can help you through the job search process can be invaluable. They can teach you the ins and outs of navigating the specific industry’s hiring process, and they will also know what your resume should look like and give you tips on earning relevant industry credentials.

    And I have one final word of caution for you. There are lots of educational programs out there, both online and on campus, that are very, very expensive—especially when you compare them to the earning potential of your new career. Be a smart consumer and make sure that the price you’re paying for your education is reasonable for the amount you can expect to earn your first few years out of school. To give you another example from our catalog, we offer a Pharmacy Technician program for just under $2,000. On average pharmacy technicians earn over $14 for an annual average of about $30,000. That makes your training costs about 6% of what you can earn your first year out of school. That is a reasonable price for education. However, there are pharmacy technician programs out there with tuition prices of over $30,000—which is definitely not a reasonable price for your education.

    Choosing a quality online training program is really no different than anything else in life. Be a smart consumer, do your research, and know what you’re looking for and you should be just fine.

    If you’d like more information on Career Step’s online career training programs, please visit us online at

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