No Further Extensions for ICD-10 and MU Stage 2

strike before midnightUpdate:  On April 1, 2014, President Obama signed into law the “Doc Fix” bill, Public Law 113-93, which extends the deadline for ICD-10 for an additional year.  Section 212 of this law prohibits the Secretary of Health and Human Services from adopting ICD-10 code sets prior to October 1, 2015.

Everyone is a-twitter (pun intended) about the announcement on Thursday, February 27, 2014, from Marilyn Tavenner, the Administrator for the Centers for Medicare & Medicaid Services (CMS), that the deadline for adoption of ICD-10 will not be extended. Tavenner was the keynote speaker at the HIMSS14 conference, and numerous tweets from HIMSS attendees highlighted her assertion that CMS will stand firm on the October 1, 2014 deadline. All entities covered by the Health Insurance Portability and Accountability Act (HIPAA) must be prepared to use ICD-10 codes on transactions by this date.

Tavenner also affirmed that the deadlines for Stage 2 Meaningful Use (MU) will not be extended. Providers who are not meaningful users of Certified Electronic Health Record (EHR) Technology under the Medicare EHR Incentive Programs will face a penalty, in the form of Medicare payment adjustments. These payment adjustments will be applied beginning on January 1, 2015.

On February 21, 2014, the American Medical Association (AMA), the American Hospital Association (AHA) and 46 additional well-respected health care groups banded together to request the U.S. Department for Health & Human Services extend the deadlines for providers “to implement 2014 Edition Certified EHR software and meet the Program requirements (Stages 1 and 2) through 2015.”  The letter expressed concerns with rushed implementation and explained that providers need “adequate time to learn how to use the newly deployed technology, including examining staff assignments, workflows, and practice processes” or patient safety could be impacted.

CMS apparently was not moved by these arguments, but FierceHealthIT reports Tavenner softened this news by adding that CMS “would be more flexible about providing hardship exemptions for providers and vendors truly struggling to meet the incentive program’s requirements.” CMS currently provides hardship exemptions in the following areas for eligible hospitals, critical access hospitals and eligible professionals:

  •  Infrastructure — Providers are in an area without sufficient internet access or face insurmountable barriers to obtaining infrastructure (e.g., lack of broadband).
  • New Providers — New providers that would not have had time to become meaningful users can apply for a limited exception to payment adjustments. The hardship exception is limited to one full-year cost reporting period.
  • Unforeseen Circumstances — Examples may include a natural disaster or other unforeseeable barrier.

In addition, eligible professionals also may be entitled to a hardship exception if they lack patient interaction or they lack control over the availability of certified EHRs for more than 50% of patient encounters.  The Eligible Professional payments adjustments and hardship exceptions are detailed by CMS here. Certain eligible professionals who provide more than 90% of their professional services in either the inpatient or emergency department of a hospital may bypass MU.

Recognizing that everyone is scrambling to implement certified EHR technology by the deadlines, which is overwhelming the EHR vendors who are attempting to meet this demand, Tavenner announced that CMS would be adding hardship exemptions for situations where a vendor cannot deliver tested, certified software updates in time or if a vendor goes out of business. More detailed information on how to apply for a hardship exception is expected to be posted on the CMS EHR Incentive Programs website in the future. Click here for additional information from CMS on the Stage 2 requirements and tips for qualifying for hardship exemptions. 

Health Data Management reports it spoke with another CMS official, who explained that while the Stage 2 deadline is firm, CMS plans to be more realistic and “meaningful” with Stage 3 requirements. Stay tuned to the Wyatt HITECH Law blog for further developments on the impending hardship exemptions and other EHR incentive program developments.

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