CMS Announces Official Delay of ICD-10 Implementation


The Centers for Medicare & Medicaid Services (CMS) has published the final rule on the ICD -10 diagnosis coding system. 


The rule makes “official” the proposed one-year delay – from October 1, 2013, to October 1, 2014 – in the compliance date for use of the ICD-10 diagnosis and procedure codes. 


The Administration adopted a one year delay in response to advocacy efforts on the part of organized medicine and received a lot of flak from other stakeholder groups for this decision.  


The AMA had successfully laid out important reasons for stopping the implementation of ICD-10.


However, outright repeal of ICD-10 has been a divisive issue for the health care industry and as more information is received, we will keep you apprised.  


The ICD-10 final rule can be accessed at the link below.



Final Rule Released on Stage 2 EHR Incentive Payment Program


The Centers for Medicare & Medicaid Services (CMS) published the final rule for Stage 2 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs at the link below. The rule provides new criteria that eligible professionals (EPs) must meet in order to successfully participate in the EHR Incentive Programs. 


Rule Provisions


Through the Stage 2 requirements of the EHR Incentive Programs, CMS will expand meaningful use of certified EHR technology. The rule consolidated several existing Stage 1 objectives and added new objectives for Stage 2.


There will be 20 measures for EPs (17 core and 3 of 6 menu) in Stage 2.


Stage 2 Timing


In the Stage 1 meaningful use regulations, CMS established an original timeline that would have required Medicare providers who first demonstrated meaningful use in 2011 to meet the Stage 2 criteria in 2013.


The Stage 2 rule delays the onset of Stage 2 criteria. Any provider that attests to Stage 1 of meaningful use in 2011 or 2012 will attest to Stage 2 in 2014 instead of 2013. Therefore providers will not be required to demonstrate Stage 2 of meaningful use before 2014.


The rule also finalizes several exemptions from the penalties, including a new exemption for physicians who practice in multiple locations and do not have control over the availability of a certified EHR system — for instance, surgeons who see most of their patients in an ambulatory surgical center.

By statute, CMS is required to penalize Medicare physicians who do not participate in the EHR incentive program, beginning in 2015. Any physician who is not achieving meaningful use by Oct. 1, 2014, will be subject to a 1 percent penalty. However, the final rule exempts from penalties physicians:


·        Who practice in an area without high-speed internet;

·        Who are in their first two years of practice;

·        Whose ability to use an EHR system was met with unforeseen circumstances (e.g., a natural disaster or the EHR vendor going out of business);

·        Who lack direct patient contact; and

·        Who have 50 percent or more of their patient encounters at locations where they do not have control over the availability of a certified EHR.


The American Academy of Ophthalmology (AAO) strongly pushed for exemptions for physicians who are over the age of 65, have a low threshold of Medicare billing or are solo practitioners. Unfortunately, CMS did not adopt exemptions for any of these physicians.

The criteria established in the final rule will allow ophthalmologists to continue to succeed in the program through stage two of meaningful use. CMS has finalized several meaningful-use measures advocated by the Academy that will be more relevant to specialty practice than previous requirements.


These include a new optional measure for accessing patient images through the EHR.


CMS has also lowered the reporting thresholds for more challenging and controversial meaningful use measures, including a measure opposed by the Academy that would measure physicians based on their patients’ use of an online patient portal.

Again, stage two will not begin until 2014 in order to allow physicians and EHR vendors more time to implement the new requirements.


The Academy will update its Ophthalmology Attestation Guide (see link below) to assist ophthalmologists as they transition from stage one to stage two.  Continue to check this link to see when the updated version is available.

Stage 2 EHR Summary “Cheat Sheet”

A summary of the Stage 2 final rule that highlights key changes to the EHR Incentive Programs is provided here

The end of the tip sheet contains a complete list of the Stage 2 core and menu objectives for both EPs and eligible hospitals and CAHs.

The tip sheet is available on the CMS website at the link below and should be reviewed in its entirety to effectively prepare for Stage 2 requirements.

James A. McNally, CPC

Health Care Consultant Services