Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

The Fate of ICD-10 Tied to Temporary SGR ‘Doc Fix’

The temporary fix of the Sustainable Growth Rate (SGR) methodology which prevented a 24% cut in Medicare fees back on January 1, 2014, expires today, March 31, 2014. H.R. 4302, which passed last Thursday with a controversial voice vote in the House, provides another temporary patch to the SGR by alleviating the steep decrease in Medicare fees for another 12 months.However, the bill currently being considered also delays the transition of ICD-9 to ICD-10 until at least October 1, 2015. The Senate is expected to vote on the bill this evening.

Healthcare industry leaders are divided on both major provisions of the bill. While provider organizations do not welcome the drastic cut in Medicare payments, many were hopeful that a permanent fix to the SGR would be implemented before the March 31 deadline. Earlier bicameral, bipartisan efforts across three different Congressional committees produced a long-term solution to the SGR; however, disagreements over how the plan would be paid for have unraveled those efforts. Some experts fear that another temporary delay may completely derail those earlier negotiations for permanent reform.

Groups also are divided on another delay of ICD-10. While organizations like the American Medical Association (AMA) and the Medical Group Management Association (MGMA) have pushed for delay, contending that the industry is not ready for the massive overhaul that comes with the transition, other groups like the American Health Information Management Association (AHIMA) say that another ICD-10 delay will cost the healthcare industry billions of dollars and further delay the benefits of better reporting, including a payment reforms toward quality rather than quantity.

Meanwhile, the Centers for Medicare and Medicaid Services (CMS) has instructed all Medicare Administrative Contractors (MACs) to hold claims for April 1, 2014, services and beyond for 10 business days (through April 14, 2014). Claims for services prior to April 1, 2014, will be processed with no delay, and CMS anticipates minimal cash flow problems because under current law, clean electronic claims are not paid any sooner than 14 calendar days after the date of receipt, anyway.

Readers interested in communicating with their legislators about this issue can email them through the Fix Medicare Now website, call them through the AMA’s grassroots hotline (800) 833-6354, or contact them directly with email addresses and phone numbers available via the Contact Elected Officials page of USA.gov.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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