Congress passes bill to delay ICD-10 compliance deadline by one year


April 1, 2014 – The Senate passed the Medicare sustainable growth rate (SGR) bill, which delays cuts of physician reimbursements under Medicare. The bill also delays the implementation deadline for ICD-10 billing codes until October 2015. The House passed the same legislation last week. The bill now moves to President Obama, who is expected to sign the bill into law.

This bill, H.R. 4302, Protecting Access to Medicare Act of 2014, mainly creates a temporary “fix” to the Medicare sustainable growth rate (SGR). A seven-line section of the bill states that the Department of Health and Human Services (HHS) cannot adopt the ICD–10 code set as the standard until at least October 1, 2015. The healthcare industry had been preparing to switch to the ICD-10 code set on October 1, 2014.

The legislation:

  • Delays the deadline to switch to ICD-10 codes until Oct. 1, 2015
  • Provides a 0.5% Medicare pay bump from April 1, 2014 thru December 31, 2014 and a zero percent payment update from January 1, 2015 to March 31, 2015
  • Revalues certain physician payment codes
  • Creates a program that promotes proper use of diagnostic tests and treatments and discourages their overuse
  • Authorizes a multistate pilot program to raise standards for mental health services and improve integration of care

Introduces a requirement for hospitals to comply with the “two-midnight” rule for inpatient reimbursement, and pushes back recovery audits of allegedly unnecessary claims until March 2015