News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
Sign In

Providers, Payers and CMS Gear Up for ICD-10 Implementation, but Will They Be Prepared for Launch by October 1, 2014?

Pathologists and medical laboratory managers have only nine months to prepare their labs for ICD-10 implementation

Most clinical laboratory managers and pathologists know that October 1, 2014, is the date for implementation of ICD-10. After that date, each Medicare claim submitted by a medical laboratory must include the ICD-10 code provided by the referring physician.

This is a unique reason why clinical laboratories and pathology groups have keen interest in a smooth transition from ICD-9 to ICD-10. Medicare will reject clinical laboratory test claims that either don’t have an ICD-10 code or have an incorrect ICD-10 code. Thus, labs hope that their client physicians make a smooth transition from ICD-9 to ICD-10. (more…)

HHS Proposes One-Year Delay for ICD-10 Implementation: Is This Good News for Clinical Pathology Laboratories?

AMA opposition to ICD-10 deadline moves HHS to reconsider, while leaving some transition-ready providers rankled

When it comes to implementation of ICD-10 in the United States, the “do it later” crowd seems to have convinced the Department of Health and Human Services (HHS) of the need to once again move back the compliance date for ICD-10. On April 9, HHS announced a proposed rule to defer implementation by one year, with a new effective date of October 1, 2014.

Clinical laboratories and anatomic pathology groups have a big stake in a successful transition from ICD-9 to ICD-10. Among other reasons, Medicare Part B claims for medical laboratory  tests must be submitted with an appropriate ICD code [provided by the physician who ordered the lab tests] for the clinical lab or pathology group to be paid by the Medicare program.

Hospitals, Physicians, and Clinical Pathology Laboratories Scramble to Prepare for Use of Form 5010 Beginning January 1, 2012

Some medical laboratory organizations risk coming up short on the deadline for implementation of 5010 standards

Less than eight weeks remain before the January 1, 2012, deadline for implementation of Form 5010. Every sector of the healthcare system—from government and private payers to hospitals, physicians, pathologists, and clinical laboratories—is involved in this important healthcare reform.

Many providers and payers are scrambling to meet the Health Insurance Portability and Accountability Act (HIPAA) version 5010 compliance deadline. This is the latest version of standards for the conversion of electronic health records (EHRs).

The Centers for Medicare and Medicaid Services (CMS) continues to maintain a hard line position regarding the deadline, according to an article in Modern Healthcare. “There is no wiggle room,” Denise Buenning, Director of the Administrative Simplification Group in CMS’ Office of E-Health Standards and Services, stated. “We’re holding fast to the date.”


Clinical Laboratories Beware: Many Payers May Not Be Ready for HIPAA 5010 on January 1, 2012

Bigger challenge will be adoption of ICD-10 across entire U.S. healthcare system in 2013

Two disruptive events in the world of coding, billing, and claims reimbursement are about to engage the full attention of clinical laboratories and pathology groups. First is implementation of HIPAA 5010 forms for claims submission by all types of healthcare providers. This is scheduled to occur on January 1, 2012—just seven months away!

Second is implementation of ICD-10 codes. Federal law currently requires all payers and providers to begin using ICD-10 on October 1, 2013. On that date, the existing ICD-9 codes will no longer be used.


Good News for Labs: HHS Delays Implementation Deadline for ICD-10 to 2013, Version 4010/4010A1

Pathologists and lab directors concerned about training staff to implement the new ICD-10 code sets can relax-but only just a bit! The federal Department of Health & Human Services (DHHS) has pushed back the compliance deadline for implementing the International Classification of Diseases, 10th Revision (ICD-10) code sets. The new implementation deadline of October 1, 2013; replaces the existing deadline of October 1, 2011.

As it announced this extension in implementation of ICD-10 on January 15, HHS also set a date of January 1, 2012, for implementing the so-called X12 standard, Version 5010, for certain electronic health care transactions. Version 5010 is an important prerequisite to adopting ICD-10 and includes updated standards for claims, remittance advice, eligibility inquiries, referral authorization, and other administrative transactions. Version 5010 accommodates the ICD-10 code sets, which are not supported by Version 4010/4010A1, the current X12 standard, HHS said.

These two implementation dates give labs additional time to prepare and train for using the new codes. Labs will find the implementation of ICD-10 to be a costly process, in part because ICD-10 uses 155,000 seven-digit codes, compared with the existing 17,000 codes in ICD0-9. Bloomberg news reported on January 14 that the new codes will be a “nightmare” for healthcare providers.

In a report last year, Nachimson Advisors, LLC, estimated that every provider will incur conversion costs in at least six ways. Organizations representing physicians and laboratories, including the American Medical Association and the American Clinical Laboratory Association (ACLA)  commissioned the report, which projected the ICD-10 implementation costs for small, medium, and large physician groups.

The Nachimson Report calculated that the typical small group of three physicians would incur costs of $83,290 to comply with ICD-10. A typical medium-sized group of 10 physicians would spend $285,195, and a typical large physician practice of 100 providers would spend $2.7 million. (See “ICD-10 Conversion Costs Underestimated by HHS,” The Dark Report, Oct. 20, 2008.) These costs include expenses for:

1) education;

2) process analysis;

3) changes to superbills;

4) information technology;

5) documentation; and,

6) cash flow disruption

Conversion costs will be even higher for labs. That’s because labs must fund extensive changes in their information systems. Labs will also need to train not only staff, but also referring physicians. One large national lab estimated that it will spend $40 million to convert to ICD-10.

Armed with the knowledge about these high costs to implement ICD-10 and train referring physicians on the new codes, physician groups and ACLA have lobbied Congress to order HHS to delay implementation. HHS received more than 3,000 comments on the ICD-10 proposal, said Kerry Weems, acting administrator of the federal Centers for Medicare & Medicaid Services (CMS).

“A number of commenters asked for a delay in the compliance dates for both ICD-10 and Version 5010, citing implementation costs, the need to train health care personnel, and to assure ample time for testing between trading partners,” noted Weems. “HHS recognized these concerns and the final rules delay the implementation dates between the proposed and final rules by 21 months for the 5010 standards, and by 24 months for the ICD-10 codes.”

Medical laboratories and pathology group practices should already have a strategy in lace for handling the transition to ICD-10 codes. This two-year extension may be welcome today, but the United States is a full two decades behind the rest of the world in its use of ICD-10 codes. So further delays in ICD-10 implementation beyond 2013 should not be expected.

Related Articles: