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Making Sense of Healthcare's Regulatory Alphabet Soup

Making Sense of Healthcare's Regulatory Alphabet Soup

It's been a pretty significant two weeks for physicians and medical practices nationwide with the implementation of the ICD-10 coding system and significant rule development on the meaningful use of EHRs.  For physicians and practices who often feel like they are on the Titanic of government regulations, this is just the tip of the proverbial iceberg.

As part of their "Washington Update" at this year's Medical Group Management Association (MGMA) Annual Conference in Nashville, Tenn., on Monday (Oct. 12), Jennifer McLaughlin, a senior government affairs representative for MGMA, and Suzanne Falk, a government affairs representative, also at MGMA, educated attendees on the current status of the sea of regulatory alphabet soup affecting their practice's bottom line.

The duo provided major update and guidance on government regulations, including:

In the 12 days since the rollout of ICD-10 coding system, both McLaughlin and Falk noted that things have been "quiet" at practices, with initial payments carrying the new codes being processed and even paid.

Jennifer McLaughlinJennifer McLaughlin
"This has a lot to do with the preparation and due diligence [over the years]," noted McLaughlin.

The next major things to watch, she noted, will be CMS' handling of non-specific ICD-10 codes on claims submitted by practices for Medicare patients. The federal agency announced a one-year grace period for providers, where it will not deny claims carrying such codes if they are from the appropriate "family" of codes for the condition.  McLaughlin said that while this will prevent the "floodgates" of denials from Medicare auditors, it won't stop all ICD-10-related issues with these claims.

Another major thing to watch, McLaughlin noted were the four U.S. state Medicaid plans — in California, Louisiana, Maryland, and Montana — who are not ready for ICD-10 and are actually reverse coding claims from the new code set back to ICD-9. "Our concern here is that this will lead to pending or rejected claims in these states, so we'll be watching that," she noted.

NEXT: Meaningful Use


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