July 1

Well, half of 2015 has already flown by and we find ourselves three months away from the ICD-10 coding set compliance date. The codes are used to identify patient diagnoses and hospital procedures. Muy imporanto for health plans.  The systemic change blows up the number of codes exponentially.  CMS, which regulates the HIPAA transaction and code sets, is cheering on the start of the new system. The doctors are freaking out. The health plans, which are legally bound to implement the massive change, are concerned that Congress may require them to manage two coding systems during a transition period.

Under HIPAA’s original “if you build it they must come” system, health plans must comply with the changes; doctors only have to comply if they engage in electronic transactions. Five years after HIPAA was enacted Congress changed the Medicare law to require medical practices to submit Medicare claims electronically. That’s what is causing doctors to freak out. CMS is saying that it will not pay Medicare claims with dates of service on or after October 1 unless the claim uses the ICD-10 codes. Health plans understandably are following CMS’s lead.

Health Analytics reports that the lobbyists are fighting up on Capitol Hill over this issue, and it may come down to the wire. HIPAA was enacted to facilitate electronic claims transactions and this coding change does little if anything to push that ball forward. The change is touted as a boon to public health analysts. A train wreck may be coming. It won’t be as dramatic as the healthcare.gov catastrophe in October 2014, but it could be bad. The FEHBlog is not optimistic.

The FEHBlog noted on Monday the interesting development that a federal union AFGE has sued OPM and an OPM contractor over the data breach. As this Nextgov article accurately reports,  these data breach lawsuits don’t have a great track record in court because of the inherent difficulty in proving sizeable data breach damages. Here, however, there is an unprecedented twist — the breach of the SF-86 background check forms. Those affected people unfortunately may have an easier time proving sizeable damages but the FEHBlog is not certain that these unique circumstances can be adjudicated in a class action. It’s not a simple case. Time will tell.

Also it’s worth noting this Federal Times report that the government is warning federal employees and annuitants about spear phishing scams related to the OPM breach.  Take care.