GE Healthcare Camden Group Insights Blog

CMS Subtly Sets Oct. 1, 2015 Conversion Date for ICD-10

Posted by Matthew Smith on May 2, 2014 9:12:00 AM

ICD-10, CMSIn a nearly 1,700-page proposed rule on fiscal year 2015 inpatient payment policies released Wednesday, CMS appears to have quietly set Oct. 1, 2015, as the new ICD-10 implementation deadline, Health Data Management reports (Goedert, Health Data Management, 5/1). 

HHS “expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning Oct. 1, 2015,” the CMS statement said. “The rule will also require HIPAA-covered entities to continue to use ICD-9-CM through Sept. 30, 2015.”


U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures. The switch means that health care providers and insurers will have to change out about 14,000 codes for about 69,000 codes.

Earlier this month, President Obama signed into law legislation (HR 4302) that pushes back the ICD-10 compliance date until at least October 2015 (iHealthBeat, 4/25). 

Health care stakeholders have been pushing the agency to provide more clarity on the new deadline.

For example, a coalition of health care organizations last month sent a letter to CMS Administrator Marilyn Tavenner urging the agency to clarify the ICD-10 implementation deadline as soon as possible.

The group -- which includes the American Health Information Management Association, America's Health Insurance Plans and the College of Healthcare Information Management Executives -- urged the agency not to extend the compliance date beyond October 2015 and to announce Oct. 1, 2015, as the official deadline.

They wrote that coalition members "have already expended an enormous amount of time, effort and resources in preparing for the transition to ICD-10 in accordance with the original timeline given by HHS." They added, "Continued uncertainty relative to the ICD-10 implementation date will add significant demands on limited resources and will measurably increase the overall cost of completing the transition" (iHealthBeat, 4/17).

Details of Proposed Rule

The proposed rule includes a request for comment on the ICD-10 strategy. It states, "The ICD-10-CM/PCS transition is scheduled to take place on Oct. 1, 2015. After that date, we will collect non-electronic health record-based quality measure data coded only in ICD-10-CM/PCS."

CMS is seeking feedback on how "if at all, [it] should adjust performance scoring under the Hospital [Value-Based Purchasing Program] to accommodate quality data coded under ICD-10-CM/PCS, or otherwise ensure fair and accurate comparisons under the Hospital VBP Program once the transition date has passed" (Health Data Management, 5/1).

Note: The request for comment on the ICD-10 deadline can be found on pages 648-650 of the proposed rule.

Topics: CMS, ICD-10, Final Rule

ICD-10 Delay Approved By Senate; Deadline Moved to 10/1/2015

Posted by Matthew Smith on Apr 1, 2014 9:26:00 AM

ICD-10 DelayedBy a vote of 64 to 35, the U.S. Senate on March 31 approved legislation that includes a provision to delay the ICD-10 implementation deadline by one year to Oct. 1, 2015. The bill will be sent to President Obama for his expected signature.

The so-called "Doc-Fix" bill also suspends Medicare's sustainable growth rate (SGR) formula that would have cut the physician reimbursement rate this year by nearly 24 percent. Congress had until today to pass the legislation that averts the payment cut and further delays Medicare cuts to physicians until April 1, 2015. In addition, the bill further delays enforcement of the Medicare two-midnight payment policy for hospitals until March 2015.

The Senate conducted a straight “up or down” roll call vote on the bill, which prevented senators from removing any sections of the bill, including the ICD-10 delay provision. Previously, in a March 27 voice vote, the House of Representatives approved the fast-track legislation that was based on a bipartisan deal struck between Senate Majority Leader Harry Reid and House Speaker John Boehner. 

In an opening statement earlier this afternoon to begin the Senate's consideration of H.R. 4302, the Protecting Access to Medicare Act of 2014, Reid acknowledged that the 12-month temporary SGR fix in the bill "is not perfect, not ideal" but it "ensures that Medicare patients will be able to see their doctors." The legislation is Congress’ 17th temporary Medicare patch. Sen. Ron Wyden (D-Ore.), recently installed as chairman of the Senate Finance Committee, tried but failed to get the Senate to consider a permanent Medicare SGR fix during debate on the bill.

Topics: CMS, AMA, ICD-10, AHIMA, HIMSS, Doc Fix

Senate to Vote Monday on ICD-10 Delay

Posted by Matthew Smith on Mar 28, 2014 2:13:00 PM
ICD-10, House Bill,Courtesy of HIMSS Government Relations

On Thursday, March 27th, the U.S. House of Representatives approved by voice vote HR 4302, a new bill that would create a one-year patch for the Sustainable Growth Rate (SGR) formula, further delaying action on replacing the current formula until April 2015. 

The bill would also delay the conversion to ICD-10 by one year to October 2015:


The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD–10 code sets as the standard for code sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d–2(c)) and section 14 162.1002 of title 45, Code of Federal Regulations.

The bill now awaits action in the Senate, which has announced plans to vote at 5:30 pm on Monday, March 31st, with 60 votes needed for passage.  The current short term SGR "doc fix" expires at midnight Monday.

“HIMSS is monitoring the developments in the House and Senate on ICD-10," said Tom Leary, HIMSS Vice President of Government Relations. "We continue to focus our efforts on supporting our stakeholders by providing education, resource and tools to help them make the conversion to ICD-10 in the most effective and efficient ways.”

HIMSS offers many resources for those making the transition from ICD-9 to ICD-10 in the ICD-10 Playbook

In February, Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner told HIMSS14 attendees that the October 1, 2014 start date for ICD-10 remained firm. 

Topics: CMS, AMA, ICD-10, AHIMA, HIMSS, Doc Fix

BREAKING: House Bill Would Delay ICD-10 Deadline Until at Least 2015

Posted by Matthew Smith on Mar 26, 2014 2:53:00 PM

ICD-10, House BillThe planned implementation of a nationwide conversion to the ICD-10 family of diagnostic and procedural codes would be extended at least a year by a House Ways and Means Committee bill aimed at providing the annual fix of the physician sustainable growth-rate formula.

“The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10 code sets as the standard,” states section 212 of the proposal. 

In late February, CMS Administrator Marilyn Tavenner told an industry conference, “There are no more delays and the system will go live on Oct. 1,” of this year, which was the original scheduled implementation date for ICD-10.

According to an announcement by the American Health Information Management Association (AHIMA), the bill is slated to be voted by the House of Representatives on March 27. “This bill was negotiated at the leadership level in the House and Senate, and it is expected that there will be no debate before calling the bill to vote,” the association revealed to its constituents.

Additionally, AHIMA has urged its members and other stakeholders to contact their representatives and senators not for the purpose of supporting the delay but instead of removing the ICD-10 provision from the SGR bill. The association has made the following script available to would-be callers:

Hello Representative XX/Senator XX, my name is XXX and I am a concerned member in your district, as well as a healthcare professional. I am calling to voice my opposition to the language in the SGR patch that would delay ICD-10 implementation until October, 2015. CMS estimates that a 1 year delay could cost between $1 billion to $6.6 billion. This is approximately 10-30% of what has already been invested by providers, payers, vendors and academic programs in your district. Without ICD-10, the return on investment in EHRs and health data exchange will be greatly diminished. I urge you, Representative XX/ Senator XX to oppose the ICD-10 delay and let Speaker Boehner and Senate Majority Leader Reid know that a delay in ICD-10 will substantially increase total implementation costs in your district as well as delay the positive impact for patient care.

Associations such as the American Medical Association (AMA) have asked their members to convince Congress of the need for a timely SGR repeal, with the failure to do by March 31 leading to a 24-percent cut in payments to physicians. But this advocacy does include any mention of the recent inclusion of an ICD-10 delay into the debate over the SGR.

Topics: CMS, AMA, ICD-10, AHIMA

What CMS is Saying About Stage 2 Meaningful Use at HIMSS14

Posted by Matthew Smith on Feb 25, 2014 12:56:00 PM

Stage 2, Meaningful Use, EHR, Health DirectionsAt HIMSS14, the message from healthcare organizations and professionals about the EHR Incentive Programs is clear and consistent: those working to implement all the changes required of federal health IT initiatives want more time to complete their tasks.

From ICD-10 to Stage 2 Meaningful Use, they are petitioning the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) to provide flexibility. Although these calls for action may not lead to the desired end, CMS and other agencies are listening.

“We have definitely heard that and are implementing more flexibility,” Elizabeth Holland, Director of the HIT Initiative Group in the Office of E- Health Standards and Services at CMS, told about the feedback the federal agency has received from providers about the EHR Incentive Program for Medicare, particularly Stage 2 Meaningful Use. “We are looking at flexibility options. We’re working very closely with our lawyers to see how much flexibility we have. We’re really looking to see what we can possibly do.”

It is not just the interactions with attendees at HIMSS14 or the public advocacy on the part of healthcare associations that have caught the attention of CMS. There are also the results of Stage 1 Meaningful Use. Trends in attestation show just how ready eligible professionals (EPs) and hospitals (EHs) are for the next phase of meaningful use.

“For me, the most interesting part is that we have had a whole lot of people coming in for the first time,” Holland explains. “It’s well over 20,000 and I wouldn’t have thought that so many people would have waited until the very end to attest for the first time with all these returning people coming in as well. We’re happy with the volume. But how high is it going to go; how many people are going to come in?”

With so many eligible providers coming in at the end, how likely are they to be ready for Stage 2 Meaningful Use? The answer is not very. But it’s not entirely the fault of providers. Without EHR technology certified for Stage 2, EPs and EHs cannot achieve meaningful use.

“One of the things we were worried about is the deployment of the 2014 products,” continues Holland. “We’ve looked to see if people are attesting for 2014 yet, and we’ve had some hospitals that have attested for 2014 but for Stage 1 — so new hospitals coming on. We haven’t had people come in for Stage 2 yet.”

If 2014 Edition certified EHR technology is not available to providers, how can that be held against them? According to Holland, a plan is in the works for these EPs and EHs to claim a hardship exemption. “We just had a change to our hardship exception form — that we explicitly added that to the form. Before it was hard to understand that you could fit into a category so it’s much more clearly spelled out on the form,” she reveals.

And that flexibility shouldn’t be limited to this next phase of meaningful use. It will influence Stage 3 Meaningful Use as well.

“At this point, Stage 3 has been pushed out, but that’s really from the practical point,” says Holland. “People are still doing Stage 2 certification and if we all of a sudden start pushing too hard on Stage 3, people are really going to be pushed. We don’t have any experience yet from Stage 2 to know and inform our development of Stage 3.”

While the legislation is expected to appear in the fall, its importance pales in comparison to the emphasis being placed on the health IT initiatives bearing down on health systems, hospitals, and physician practices right now. Perhaps the good news is that federal agencies are listening and looking to assist them.

EHR, Meaningful Use, Electronic Health System

Topics: Meaningful Use, CMS, ICD-10, Stage 2

Free Practice Management Breakfast Seminar for Independent Physicians & Staff: February 20th | Suburban Chicago

Posted by Matthew Smith on Feb 19, 2014 11:25:00 AM

Independent Physician AdvisorsJoin the Independent Physician Advisors tomorrow, Thursday, February 20th at 7:30 am in Oakbrook Terrace for a complimentary breakfast and seminar, Profitable Practices: Overcoming the Unpredictability of Reimbursement.

Topics to be Covered Include:

  • Impact of ICD-10
  • E/M Coding Challenges
  • Minimizing Denials & Collections
  • Increasing Patient Satisfaction

Presented by:

Bradley A. Netzel

Deena Wojtkowski
Associate VP of Client Services, ebix, inc.

Tony Moscato

Tony Muscato
VP/Owner, Creditor's Discount & Audit Company


7:30am    Hot Breakfast & Networking
8:00am    Presentation 
9:30am    Q&A and open networking


Redstone American Grill
13 Lincoln Center
Oakbrook Terrace, IL 60181
(630) 268-0313


Independent Physicians, Practice Management


This event is complimentary, however advanced registration is required. We ask that attendance be limited to independent physicians and their office staff.

To register for this event, please click the button, below. In the box marked, "How did you hear about this seminar?" please enter: Health Directions Blog.

Topics: Reimbursement, ICD-10, Coding, Denials, Collections, Independent Physician Advisors, Patient Satisfaction

Infographic: Physicians Cite Challenges to Practice Profitability

Posted by Matthew Smith on Jun 3, 2013 10:29:00 AM

Infographic, Healthcare, Health DirectionsPhysicians are almost two-thirds more likely to foresee a negative profitability trend, rather than a positive one, in the year ahead according to recent research report by cloud-based health technology provider,CareCloud and QuantiaMD, online and collaboration physician platform. The findings gathered through online surveys and related discussion groups report an overall downtrend in profitability among US physician practices with reform requirements as the leading source of financial burden.

Declining reimbursements, rising costs, ACA, coding/documentation changes including ICD-10, and EHR adoption were identified as having the most negative impact on practice profitability. Despite these challenges, the report concludes that most physician practice owners want to stay independent. Physicians also identified improved billing and technology as the greatest keys to improving the financial performance of their practices.


 The Practice Profitability Index (PPI) was created to provide a voice to US physicians practices about issues that impact their financial performance and operational health. 5,012 physicians contributed their insights to the PPI during April of 2013 and, functions as a barometer for the operational and financial health of private practices in 2013. The 2013 report identified a confluence of challenges that make staying profitable increasingly difficult for physician practices today.

Key report findings include:

  • 1-in-3 physicians see overall profitability trending downward in 2013
  • 65% say declining reimbursements are the greatest threat to profitability
  • 59% spend at least one day per week on paperwork instead of treating patients
  • 48% say they lack the resources to accept any of the 30 million new patients from the ACA
  • Only 9% are very confident in their current processes for getting paid
  • Plus, profitability data is broken down by state, specialty and more…

Some of key data points in the report have been highlighted in the infographic visualization shown below:

Infographic, Practice Profitability, Practice Management


Strategic Provider Planning, Specialty Mix

Topics: ACA, Employed Physicians, employed physician practices, Employed Medical Practices, ICD-10, Coding, Practice Management

Top 10 Challenges Facing Medical Practice Group Leaders

Posted by Matthew Smith on Sep 5, 2012 11:33:00 AM

10 ChallengesMedical practice professionals responding to MGMA-ACMPE's fifth annual medical practice survey discussed some of the most glaring issues group practices face today.

Here are the top ten challenges noted from the survey of more than 1,250 respondents.

  1. Managing finances with the uncertainty of Medicare reimbursement rates.
  2. Preparing for reimbursement models that put greater financial risk on practices.
  3. Preparing for the transition to ICD-10.
  4. Dealing with rising operating costs.
  5. Participating in CMS' electronic health record meaningful use incentive program.
  6. Understanding the total cost of an episode of care from the perspective of the payor.
  7. Collecting payment from high-deductible health plans and/or health savings account patients.
  8. Maintaining physician compensation levels.
  9. Managing group practice finances.
  10. Recruiting physicians.

In today’s challenging healthcare environment, medical practices that lack effective management controls quickly develop problems in patient service, financial performance, and physician and staff satisfaction. While they try their best to meet these practice demands, many practices simply lack adequate knowledge of their inefficiencies.

Health Directions works with physician practices so they gain control of the business side of their medical practices. By working cooperatively with providers and office staff, Health Directions enables practices to overcome difficult challenges and identify new opportunities.

The Health Directions team members rely on their hands-on experience managing both independent and hospital-owned practices. We use our practical expertise to augment current and/or provide temporary leadership in support of long-term solutions.

Specifically, Health Directions provides the following Practice Management services:

  • Practice start-up: Health Directions coordinates every aspect of practice development: staffing, technology, clinical operations, patient flow, business office processes, revenue cycle management and managed care contracting.
  • Practice turnaround: We provide the hands-on leadership needed to reduce staff turnover, improve the patient experience, boost physician satisfaction and achieve strong profitability.
  • Interim management: Our team members provide outstanding value by using interim management to address longstanding practice issues, guide organizational transitions and consolidate operational improvements.
  • Medical practice assessment: Health Directions reviews the operational and financial aspects of the practice, including staffing, workflow, systems, billing and collections. By gathering data, interviewing key staff, observing workflow and analyzing reports.
  • Practice Education: Health Directions leads and executes practice retreats and workshops aimed at improving operations, enhancing collaboration, and building market share. To augment day-to-day practice operations, Health Directions offers a range of half-day sessions pertaining to effectivepractice management.

Let Health Directions work with you to develop efficient practice operation and increased cash flow while you advance the quality care of your patients and strategically position your practice for future growth. 

Simply click on the button below to receive our complimentary Practice Pulse checkup that will deliver estimates identifying:

  • Amount of increased practice revenue per year
  • Amount of increased collections per year
  • Amount of increased patient volume
  • Amount of reduced operational costs
Strategic Provider Planning, Specialty Mix

Topics: EHR, Meaningful Use, Medicare, Reimbursement, Physician Recruitment, ICD-10, Operating Costs, Revenue Cycle

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