Proposed Code-FLEX Act of 2015 allows providers to use ICD-9 codes for another six months


At the agencies

On July 16, the Centers for Medicare and Medicaid Services (CMS) released the first ever star ratings for home health services. Under the Affordable Care Act (ACA), CMS was directed to create a Quality of Patient Care Star Rating system for providers and to specify those star ratings by services type. CMS has already publicly released star ratings for nursing homes, dialysis facilities, hospitals, Medicare Advantage participating providers, and physicians. As with other provider types, CMS used data collected by the home health providers themselves and compared that data to the overall home health provider industry to determine a star rating for each provider. Consumers can access home health and other provider type star ratings online.

On July 22, CMS posted the 2015 Medicare Trustees Report which provides a past overview and projected financial outlook for the Medicare program. According to this year’s report, while the deficit in the Medicare fund decreased 0.87 percent over last year, the program insolvency projection remains at 2030. Echoing concerns raised by the Government Accountability Office (GAO), this report also noted that the new formula that Congress enacted into law to replace the sustainable growth rate formula (SGR) will actually be worse for physicians in the future, as compared to the SGR. Unless physicians change the way they deliver care, the pay increase enacted by Congress this year will not be sufficient to keep up with the annual Medicare Economic Index, likely resulting in a familiar pattern of physicians asking Congress to postpone payment cuts.


On the Hill

On July 10, Congresswoman Marsha Blackburn (R-TN) and Congressman Tom Price (R-GA) introduced the “Code-FLEX Act of 2015,” which would allow providers to use ICD-9 codes for another six months beyond the current ICD-10 deadline. ICD-10 codes are set to take effect October 1, 2015 and some lawmakers are concerned that many providers will not have systems in place to adhere to the new system in time. Notably, CMS had already announced that it would allow a one-year grace period for ICD-10 codes that may not be specific enough, but that they will not accept ICD-9 codes after September 30, 2015. 


In the courts

On July 23, a Third Circuit panel concluded that Geisinger Community Medical Center, a hospital based in Scranton, Pennsylvania, has the right reclassify from “urban” to a “Section 401” status. The Section 401 status allows Geisinger to be treated the same as rural hospitals in terms of certain aspects of Medicare reimbursement. The ruling in favor of Geisinger, according to the Third Circuit’s opinion, stemmed from a “plain language” reading of the statute governing Section 401 status. With this ruling, Geisinger is expected to receive a $2.6 million annual increase in its Medicare reimbursements.

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