Ten for 10: The Top Ten Reasons We Need ICD-10 Now

Many industry groups including ourselves, AHIMA and HIMSS are spreading the word out about why ICD-10 should not be delayed. Why is ICD-10 so necessary? This list of reasons, courtesy of AHIMA, shows why we need to implement ICD-10 as soon as possible:

1) It Enhances Quality Measures. Without ICD-10 data, serious gaps will remain in the healthcare community’s ability to extract important patient health information needed for physicians and others to measure quality care.

2) Research Capabilities Will Improve Patient Care. Data could be used in a more meaningful way to enable better understanding of complications, better design of clinically robust algorithms, and better tracking of the outcomes of care. Greater detail offers the ability to discover previously-unrecognized relationships or uncover phenomenon such as incipient epidemics early.

3) Significant Progress Has Already Been Made. For several years, hospitals and healthcare systems, health plans, vendors and academic institutions have been preparing in good faith to put systems in place to transition to ICD-10. A delay would cause an unnecessary setback.

4) Education Programs Are Under Way. To ready the next generation of HIM professionals, academic institutions have set their curriculum for two-year, four-year and graduate programs to include ICD-10.

5) Other Healthcare Initiatives Need ICD-10. ICD-10 is the foundation needed to support other national healthcare initiatives such as meaningful use, value-based purchasing, payment reform, quality reporting and accountable care organizations. Electronic health record systems being adopted today are ICD-10 compatible. Without ICD- 10, the value of these other efforts is greatly diminished.

6) It Reduces Fraud. With ICD-10, the detail of health procedures will be easier to track, reducing opportunities for unscrupulous practitioners to cheat the system.

7) It Promotes Cost Effectiveness. More accurate information will reduce waste, lead to more accurate reimbursement and help ensure that healthcare dollars are used efficiently.

If ICD-10 is delayed...

8) Resources Will Be Lost. For the last three years, the healthcare community has invested millions of dollars analyzing their systems, aligning resources and training staff for the ICD-10 transition.

9) Costs Will Increase. A delay will cause increased implementation costs, as many healthcare providers and health plans will need to maintain two systems (ICD-9 and ICD-10). Delaying ICD-10 increases the cost of keeping personnel trained and prepared for the transition. Other systems, business processes and operational elements also will need upgrading. More resources will be needed to repeat some implementation activities if ICD-10 is delayed.

10) Jobs Will Be Lost. To prepare for the transition, many hospitals and healthcare providers have hired additional staff whose jobs will be affected If ICD-10 is delayed.

And Finally...


We Can’t Wait for ICD-11. The foundations of ICD-11 rest on ICD-10 and the foundation must be laid before a solid structure can be built. ICD-11 will require the development and integration of a new clinical modification system. Even under ideal circumstances, ICD-11 is still several years away from being ready for implementation in the United States.

Tell us what you think of this Top 10 List. Do you agree? Or do you think ICD-10 should be delayed? We welcome your comments.

Our Response to ICD-10 Delay

The Department of Health and Human Services (HHS) announced on Thursday that they plan to delay ICD-10. With no specifics on what this delay will entail, it’s causing a lot of confusion and speculation about what is to come. We feel it was very irresponsible for HHS and the Obama Administration to make those statements without giving a clear plan. 

As we stated back in November when the AMA began opposing ICD-10, we disagree with a delay. We firmly believe conversion to ICD-10 is long overdue and delaying it will only increase health care costs and the burden on everyone.

We are very disappointed with HHS’ decision, which contradicts everything they have been saying. On CMS’ November 17^th national provider call, representative Pat Brooks said, “This is a firm implementation date, and there will be no delay.” CMS and HHS have been adamant all along that there would not be a delay. In turn, the health care community has spent a lot of time and money investing in new processes and systems. By going back on their statements, they are continuing to lose credibility.

Vendors, as well as publishers, educators, colleges, consultants, and many others, have already spent millions of dollars getting ready for conversion. It has even spurred job creation— for example new positions like ICD-10 Project Manager.  Even health care providers like hospitals and home care agencies have invested significant resources into the transition. With a delay, all of these groups will have to re-work what they've already done and it will cost more money. This added cost for vendors will be pushed down to providers, and then consumers. 

This decision also has a lot of political pressure and motives behind it. CMS’ Acting administrator Marilyn Tavenner made the announcement that they would re-evaluate the timeline at an AMA meeting. It’s important to note Tavenner is currently vying for the official appointment and AMA backed her nomination in November.

We’re also concerned about HHS’ use of the term "compliance" date, suggesting ICD-10 will be implemented per schedule, but providers will have a leeway period where they won't be found in non-compliance. In some instances a leeway period makes sense, for example with the new Face-to-Face requirements, claims were allowed to go through for three months after implementation.  But if this happens with ICD-10, it can be extremely harmful because vendors will have to work in two different sets of codes at once, in turn driving up costs and administrative burden even more.

While we anxiously await HHS’ new plan, we’ll continue our planning with the October 1, 2013 deadline in mind. We suggest no one stop in their preparations and hopefully we will quickly receive a revised plan from HHS.

Our hope is that the delay is brief because the shift to ICD-10 is a big step to improving health care in this country. It will make our healthcare system more efficient and cost effective and improve the level of care that this nation needs.

We're here to make the transition to ICD-10 pain-free and easy for home care agencies. Please contact us anytime to discuss how your organization can have a smooth transition.

Non-Compliance: The Unintentional Kind

With instances of Medicare fraud fraught in the headlines, compliance has become a hot-button issue for our industry. Companies have faced fees of up to hundreds of millions and even jail time for being found in non-compliance.

US Assistant Secretary of Health and
Human Services, Ben Sasse

Just last week at the Home Care 100 Conference, keynote speaker, former US Assistant Secretary of Health and Human Services, Ben Sasse, said that fraud and self-policing should be our top concerns. He cited shocking estimates of widespread fraud and the devastating effects it has on us as an industry, especially in Washington.

We know we don’t have to preach to you about not being fraudulent. You are all ethical individuals. But, in a lot of instances, non-compliance can happen unintentionally. With the increasing amount of regulations (several resulting from health care reform) and differing interpretations of those regulations, many times it’s the “good guys” that are getting themselves into trouble. This is especially true for the small agencies who are stretched thin and doing what they can to survive. Can you imagine if one of them got into trouble? They would not be able to weather the storm.

At Daymarck, compliance is at the cornerstone of our business. It is our first and foremost priority. We never “up-code,” “re-sequence,” or use filler codes, and we code every single home care agency the exact same. We stay up to date with the constantly changing rules and regulations to ensure our clients are 100% compliant.

You should be able to keep all the hard work that you do. That’s why no matter if you are a home health provider, institution, clinician or biller, compliance needs to be your #1 priority.

Feel free to reach out to us to discuss ways you can ensure compliance, including setting up a policy and reporting structure. 

Home Care 100 Recap

10th Anniversary ice sculpture.

Last week we attended the 10th annual Home Care 100 Executive Management Conference in Orlando, Florida. What an amazing event! We want to thank Lincoln Healthcare Events and the other partners for making it happen.

This was Daymarck’s first year attending and we did so in a big way as an executive level partner along with major healthcare companies Abbot Nutrition, Cardinal Health, GE Capital Healthcare, and several others. The professional development sessions and networking with providers and partners was invaluable as we continue to pursue our purpose of enhancing home care one code at a time.

In addition to the sponsor partners, representatives from nearly 100 providers from across the country were in attendance sharing ideas and listening to home care, business and regulatory experts discuss the state of home care in today’s environment.

As a growing medical coding company, we were excited to join together with some of the top minds in home care to learn from one another and to discuss the future of the industry. We believe this was our first step in what we hope will be a long-lasting relationship with Home Care 100.

The conference’s educational program was designed to explore innovative ways to improve patient care, strategize a plan to remain successful in this tough economy, and talk about topics we at Daymarck work to address on a daily basis – how to prepare for upcoming changes, such as ICD-10.

Incredible keynotes included Dr. Morten Hansen, co-author with Jim Collins of book Great by Choice: Uncertainty, Chaos and Luck – Why Some Thrive Despite Them All. He energized the crowd with his principles for building truly great enterprises. The closing general session keynote was James Heywood who shared his inspirational and thought-provoking presentation on the creation of PatientsLikeMe and his personal stories related to his brother and his struggle with ALS.

From Day 1, through our professional development to activities and social events, the Daymarck team was proud to be a part of this event. For more information on Home Care 100, visit www.homecare100.com. Feel free to check out our photos of the event on Facebook or visit www.daymarck.com to learn more about our offerings.

Are your vendors prepared for ICD-10?

Are your vendors prepared for ICD-10? 

This question may be on your mind lately, which is a good thing. Making sure your vendors are prepared for ICD-10 is crucial and should be as soon as possible.

Unfortunately, many home care professionals can’t say that their vendors are prepared and ready for ICD-10. When we asked this question during our ICD-10 survey at the 2011 NAHC Annual Show, nearly half (46%) said “no” or “not sure” if their vendors are prepared.

We need to get this number way down. Talking to your vendors is one of the first things you should do in your ICD-10 planning to make for a smooth transition.

When you ask your vendors (point of care, EHR, billing, etc.) what they are doing to prepare, they should be able to tell you their clear plan leading up to implementation and how they will support you during the transition. If they cannot, you may want to consider an alternative vendor.

CMS has provided more detail on what specifics you should discuss with your vendors here.

And check out our helpful list of 9 other things you should be doing now to make for smooth transition.

Defining Homebound

With many conflicting ideas,  interpretations, and vague guidance, determining if a patient is homebound can often be challenging.

Some will automatically assume a patient is not homebound if they hear they drove or left the house. But this isn’t necessarily true. A December 2010 survey we conducted to test home care professionals knowledge of homebound confirmed this notion. We found many people jumped to the conclusion that a patient was not homebound if they left the house for any reason or drove. 

Home care professionals are doing patients a disservice by not knowing the proper homebound definition. With a clearer understanding of what it is, patients can get the care they really need.

We shared Medicare’s specific homebound definition previously on our blog here. In summary, just because a patient leaves the house, or even drives, it does not mean they are not homebound. For one, any excursions related to medical appointments or religious activities cannot be taken in consideration  to a patient’s homebound status. Also, it says that a person is homebound if leaving “requires a considerable and taxing effort.” So perhaps they did drive to the grocery store, but if it took them 30 minutes to get into the car and needed the assistance of a friend or relative, they may be homebound.

The problem arises is how do you prove a “considerable and taxing effort”? The answer is documentation. Instead of saying it was difficult for a patient to get around the house, you can be more specific and say the patient was “unable to ambulate more than 100 feet without having to rest.” Its all opinions until you give quantities and specifics and even then you may still have a patient who is on the fence because there are not specific guidelines on what physical limitations qualify  someone homebound There will be some judgment calls. But with documentation which quantifies the physical or sometimes mental limitations you then have  proper documentation to back it up your decision.

Understanding homebound status will not only help us provide better care for in-need patients, but it will also save money in the long run. For example, if a patient is disqualified from homebound status, then they must leave the house frequently to receive all care and/or they miss critical appointments, which can cause them to take a downturn and end up in a hospital or nursing home. This would be much more expensive than if they got their care in the home and were able to heal there.

If you still have questions about homebound status, please contact us at nick [at] daymarck.com.

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Happy Holidays! 

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About the Caring Institute

The Caring Institute is a nonprofit 501(c)(3) organization founded in 1985 to honor and promote the values of caring, integrity, and public service. Inspired by the example of Mother Teresa, the institute believes most problems can be solved if human beings truly care for one another. We celebrate those special individuals who transcend self and devote their lives to serving the disadvantaged, poor, disabled, and dying. Their enduring dedication to caring uplifts us all and ennobles the human race.