Monthly Archives: April 2014

ICD-10: Waiting with Baited Breathe…..

To no one’s surprise, the AHIMA ICD-10 and CAC Summit on April 22-23 was quite a forum for those who attended to voice their reaction to the ICD-10 delay.  A survey of participants found:

  • 2 percent of respondents said their organization has spent more than $1 million on implementation;
  • 91 percent of respondents said ICD-10 should not go into effect in stages;
  • 50 percent of respondents would – if allowed – be interested in voluntary reporting of ICD-10 codes beginning on Oct. 1 2014;
  • 54 percent of respondents did not want the partial code set freeze lifted.

 

HIX and Potential Provider Network Regulations

Arguably, the strength of an insurer’s provider network is one of the most important things that keeps them in business in an ever-increasing competitive landscape.  If a member cannot find a provider or hospital that is participating w/that payer, it can quickly be deduced that the member will not be itching to renew their enrollment if they have much of a choice.  With the rollout of the ACA and the health insurance exchanges, the issue of provider network adequacy is becoming more magnified.  With so many choices for the consumer including the different tiers of coverage to choose from, some people may have unwittingly chosen a plan in which they are having difficulty finding a par provider.  This isn’t a new rule w/the ACA but for those who are newly insured and are not well versed in the insurance know how, they are coming across these very real issues.  What’s happening in this article in Washington State is most likely happening in other states as well.  It’s only a matter of time before HHS addresses this either formally or informally.

Signs of Life from CMS Regarding ICD-10 Delay

Since President Obama signed H.R. 4302, Protecting Patient Access to Medicare Act, on April 1 as an April Fool’s Day joke, we have been waiting for ANY communication (formal or not) from CMS as to how to proceed further.  

We were all starting to feel like Sandra Bullock’s character in Gravity all alone in space.

Alas, signs of life from CMS.  At an AHIMA meeting on Wednesday, CMS administrator Denise Buenning spoke informally about the agency’s reaction to the insertion of the ICD-10 language and the resulting delay.   It was no shock that they were as caught of guard about this as the rest of the industry.  It is also no surprise that CMS was disappointed in this development especially given they had been mobilizing resources specifically targeting some of the major at-risk industry sectors, the small physician practice.  She also promised that official guidance is coming soon.

 

HIX: How Difficult Can It Be?

From the surface, we know that health insurance exchanges are going to be fairly complex.  However, do we really have an idea of the magnitude of complexity given that we are used to a real-time or near real-time access to virtually anything and everything w/a quick search engine query.  We want what we want, when we want it.  This article gives a good overview of it using a conductor of an orchestra analogy.  The health insurance exchange hub is the conductor keeping all the musicians working together in concert at the appropriate moment.

When all the disparate instruments and musicians are working well together, they produce a beautiful musical performance.  

If even one piece is off in this equation, it can be quite jarring to hear.