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ICD-10 Adoption Brings Major Changes to Practices

  |  Issue: January 2011  |  

“As good as ICD-10 is, we are already beginning to make major revisions in ICD-10 to make it even better,” says Dr. Kay, who is chair of the Rheumatology Working Group of the Internal Medicine Topic Advisory Group for the Revision of ICD-11 at the WHO. “Currently, we are on schedule to release ICD-11 in 2015.”

However, release of the new version by the WHO is just the first step. The baseline revision is then given to the various countries, which make changes to fit their specific needs. This, too, takes time. Finally, after the U.S.–specific standards are published, CMS has to decide if it wants to make the change and, if it does, go through the entire rulemaking process.

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“ICD-11 is the least of our worries,” says Tennant. “At the earliest, adoption of ICD-11, if it even happens, is five to seven years away.”

Rude Awakening Ahead?

“The changeover is something that is of the utmost importance to all practices,” says Antanya Chung, CPC, CPC-1, CRHC, CCP, and director of practice management at the ACR. “If appropriate changes are not made by the various deadlines, practices will be in for a very rude awakening as flow of payments will come to an abrupt halt. CMS has been adamant that there would be no grace periods.”

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Denise Buenning, MsM, director of the Administrative Simplification Group (ASG) in CMS’ Office of E-Health Standards and Services, strongly reinforces that message.

“In the final rule, we extended the proposed compliance date from October 1, 2011, to October 1, 2013, to accommodate industry feedback that more time would be needed for systems and business process transitions to ICD-10, and there is stakeholder support for CMS adhering to that timeline. Because ICD-10 is foundational to many other healthcare initiatives, including reducing fraud and abuse, providing more robust patient care quality data, and supporting problem lists in electronic health records, we do not anticipate changes to the compliance deadlines for either the Version 5010 or ICD-10.”

There are two major deadlines that practices should prepare for. The first is January 1, 2012, when CMS has mandated all computer billing must be updated to use Version 5010 of the electronic standards for health transactions. The standards are required by the Health Insurance Portability and Accountability Act (HIPAA) for all transactions and not just for those submitted to government programs.

“The Version 5010 allows rheumatology practices to send and receive electronic transactions with their health plans and others,” says Robert M. Tennant, MA, senior policy advisor for the Medical Group Management Association in Washington, D.C. “This lets the practice run patient eligibility verifications, submit claims, and several other critical financial transactions.”

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