Wednesday, April 2, 2014

Congress Delays ICD-10 Implementation and Huge Medicare Fee Cut

A bill passed by the Senate Monday night and the House last week includes two critical changes affecting physician practices—one involving ICD-10-CM implementation and one concerning physician reimbursement in Medicare.

A provision in the bill that affects physicians and other clinicians nationwide delays implementation of ICD-10-CM coding until October 1, 2015. The Centers for Medicare and Medicaid Services had previously set October 1, 2014, as the date by which clinicians had to be in compliance with ICD-10-CM coding. APA has emphasized that DSM-5, released last May, already includes the ICD-10-CM codes, as well as the ICD-9-CM codes currently being used. APA has posted a guide on its website to help psychiatrists and other mental health clinicians understand the relationship between DSM-5 and ICD-10-CM.

The other key part of the bill, which focuses on multiple Medicare-related policies, postpones for the 17th time a scheduled cut in Medicare's physician reimbursement. The cut was scheduled to go into effect yesterday and would have resulted in physicians' fees being cut an average of 24%. The substantial size of the fee cut—a result of a complex formula involving practice costs and other factors known as the Sustainable Growth Rate (SGR)—reflects multiple postponements since 2003 that have caused the cut to keep growing. The House agreed to a one-year delay last week in a voice vote, and the Senate did so Monday night by a vote of 64 to 35. The legislation is now awaiting President Obama's expected signature. APA, the AMA, and almost every other physician organization have been vociferous in calling for the SGR formula to be replaced. While the need to scrap the formula and replace it with a new funding system that focuses on the quality of care provided is widely acknowledged on the Hill, proposals to do so have been introduced but have not yet been voted on by either chamber.

To read more about efforts to replace the SGR formula, see the Psychiatric News articles, "Law to Repeal SGR Clears Key Congressional Committee," and "Physician Medicare Payment Rule Needs Several Changes, APA Says."

(image: Roobcio/Shutterstock)


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