SGR

Edition 7: ICD-10 Implementation

The HIPAA act of 1996 required the department of Health and Human Services (HHS) to adopt national standards for health care transactions. Further additions under the Affordable Care Act of 2010 (ACA) included requirements to adopt the use of ICD-10 standards for diagnostic coding. As many of you are aware the date for implementation to switch to ICD-10 coding is set for October 1, 2015. This was after a delay by congress in 2014. The repeal of the SGR payment formula signed into law on April 16, 2014 made no reference to a delay of ICD-10 implementation for 2015. At this time it appears that the date of transition to ICD-10 coding remains October 1, 2015…(Read More Here)

Edition 7: ICD-10 Implementation

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The HIPAA act of 1996 required the department of Health and Human Services (HHS) to adopt national standards for health care transactions. Further additions under the Affordable Care Act of 2010 (ACA) included requirements to adopt the use of ICD-10 standards for diagnostic coding. As many of you are aware the date for implementation to switch to ICD-10 coding is set for October 1, 2015. This was after a delay by congress in 2014. The repeal of the SGR payment formula signed into law on April 16, 2014 made no reference to a delay of ICD-10 implementation for 2015. At this time it appears that the date of transition to ICD-10 coding remains October 1, 2015. (more…)

May The Era Of Medicare’s Doc Fix (1997-2015) Rest In Peace. Now What?

After seventeen years (eight months, 9 days…), over a dozen acts of Congress and innumerable reams of debate and conjecture about its fate, it’s time to say goodbye to the Medicare Sustainable Growth Rate (SGR) formula. As a proper wake, let’s take a moment to reflect on this enigma of health care economic theory. And then let’s not ever do it again.

A Brief History Of The SGR

From 1980-1990, Medicare payments to doctors were based on charges. During that period, spending under the program on physician services inflated rapidly, growing at an annual rate of 13.4 percent. Congress took note and reformed the system in two key ways: (1) rates paid for services would be determined by the resources, or inputs, necessary to perform them; and…

The New Deal

So what has been conjured, then, as the solution to the failures of the doc fix era? Before we bury the SGR under spilled champagne, we should consider what Congress is actually replacing it with. Having spent several years engineering it, there’s a lot to unpack…(Read More Here)