Health care providers, health plans, and health care clearinghouses (“Health Care Entities”) are required to comply with ICD-10 (which stands for the International Classification for Diseases, 10th Edition) on October 1, 2015, according to a new final rule (“Final Rule”) released by the U.S. Department of Health and Human Services (“HHS”). This means that Health Care Entities must be ready for ICD-10 on October 1, 2015 in order to receive reimbursement for claims.

The Final Rule officially changes the ICD-10 compliance date from October 1, 2014 to October 1, 2015 and requires Health Care Entities to continue using ICD-9 through September 30, 2015. This implementation delay is yet another delay in a lengthy transition process. The Centers for Medicare and Medicaid Services (“CMS”) stated in a press release that “[w]hile many providers, including physicians, hospitals, and health plans, have completed the necessary system changes to transition to ICD-10, the time offered by Congress and this [Final Rule] ensure all providers are ready.”

According to CMS, ICD-9 is outdated. The Final Rule explains that “ICD-10 reflects the advances in medicine and medical technology” and that ICD-10 “provides greater specificity of diagnosis-related groups; improves quality measurement and reporting capabilities; improves tracking of illnesses; and reflects greater accuracy of reimbursement for medical services.”

Marilyn Tavenner, Administrator of the Centers for Medicare and Medicaid Services (“CMS”), stated that “ICD-10 codes will provide better support for patient care, and improve disease management, quality measurement, and analytics.” Furthermore, she said: “For patients under the care of multiple providers, ICD-10 can help promote care coordination.”  

To read the Final Rule click here.

To read the CMS press release click here.