Congress Postpones ICD-10 to October 2015

All it took was one sentence, but Congress  approved postponing implementation of ICD-10 another year to Oct. 1, 2015.

The delay was slipped in to a bill temporarily fixing the sustainable growth rate (SGR) cuts that have, on paper, gone into effect today. If President Barack Obama signs the bill, a scheduled 24 percent cut in Medicare reimbursements to physicians that is to start April 1 will disappear.

Congress threw in another bonus to healthcare providers, specifically hospitals, by ordering the director of the Centers for Medicare and Medicaid Services to extend the ban on Recovery Audit Contractors (RAC) audits on claims filed under the “two-midnight rule” another six months to April 1, 2015. RACs currently are prohibited from auditing inpatient claims under the two-midnight rule from Oct. 1, 2013 to Oct. 1, 2014.

The Medicare/Medicaid system had been scheduled to switch from ICD-9 to ICD-10 on Oct. 1. Associations representing healthcare providers have been actively lobbying against the change for years and had won one postponement, from 2013 to 2014.

Here are the relevant sections of the bill passed by the House last week and the Senate yesterday:

SEC. 111. EXTENSION OF TWO-MIDNIGHT RULE.

(a) Continuation Of Certain Medical Review Activities.—The Secretary of Health and Human Services may continue medical review activities described in the notice entitled “Selecting Hospital Claims for Patient Status Reviews: Admissions On or After October 1, 2013”, posted on the Internet website of the Centers for Medicare & Medicaid Services, through the first 6 months of fiscal year 2015 for such additional hospital claims as the Secretary determines appropriate.

(b) Limitation.—The Secretary of Health and Human Services shall not conduct patient status reviews (as described in such notice) on a post-payment review basis through recovery audit contractors under section 1893(h) of the Social Security Act (42 U.S.C. 1395ddd(h)) for inpatient claims with dates of admission October 1, 2013, through March 31, 2015, unless there is evidence of systematic gaming, fraud, abuse, or delays in the provision of care by a provider of services (as defined in section 1861(u) of such Act (42 U.S.C. 1395x(u))).

SEC. 212. DELAY IN TRANSITION FROM ICD–9 TO ICD–10 CODE SETS.

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 162.1002 of title 45, Code of Federal Regulations.