The CMS ICD-10 Ombudsman Speaks Out

By: Steph Weber

All eyes in the healthcare system are on ICD-10. In order to help ensure a smooth transition and ease the burden on physicians, CMS created the position of ICD-10 Ombudsman.

Here’s a look at the appointed Ombudsman’s background, as well as what type of help physicians can expect.

Who is the ICD-10 Ombudsman?

William Rogers, a practicing emergency room physician at Georgetown University Hospital in Washington, DC, was appointed to the position in late August. He’s not new to CMS though; he’s been with the agency since 2002, originally joining the staff to assist with the launch of the Emergency Medical Treatment and Labor Act (EMTALA) and then acting in the capacity of a “non-assigned Ombudsman for ICD-10” until his recent official appointment.

Despite his vast involvement at CMS, including chairman of two open door forums and the director of the Physician Regulatory Issues Team, which aims to reduce regulatory burden on physicians, Rogers continues to practice medicine full-time.

He said he wants to use his experiences, both as a physician and CMS insider, to help others in the profession. “I know how terrible it feels to be outside of a monolithic bureaucracy and not know anybody inside,” said Rogers. “The [transition to ICD-10] has Part A implications too, but the Part A providers have been well-represented and don’t need an advocate the way that Part B practitioners do.”

What kind of help is available?

The purpose of the Ombudsman program is to make the transition from ICD-9 to ICD-10 as smooth as possible. In an effort to pinpoint related issues and answer technical questions in a timely manner, an email address (ICD10_ombudsman@cms.hhs.gov) has been established.

Physicians may direct their ICD-10 questions to this email address, and a team of trained individuals will review them and respond. The current turnaround time of 24 hours is expected to continue going forward.

Rogers will become involved when complex issues arise that span multiple agencies, organizations, or systems. He provided the recent example of “a complicated issue regarding grouper software and seventh decimal placement for home health.” Since the resolution required the involvement of groups both inside and outside of CMS, Rogers stepped in to facilitate the conversation. “This is the sort of issue that I am not going to solve…but I will facilitate and make sure that the right people are talked to,” he said.

Rogers is quick to clarify that he is not an ICD-10 expert nor a “fallback to get the technical questions answered.” Instead, he views his primary responsibility as being accessible, troubleshooting, and coordinating behind-the-scenes conversations like the one above.

“I’m the person to inform if [we’re] doing a really great job or if you’ve sent several emails and still haven’t gotten an answer,” said Rogers. “I can check into what’s going on and why we’re not meeting the goals that we set for ourselves. Whatever needs to be done we will do, because this is people’s livelihoods.”

Managing the transition

The transition to ICD-10 certainly poses its fair share of challenges. Fortunately, the Ombudsman program offers physicians another resource to navigate this significant industry change.

Rogers offers this final encouragement. “I sure understand how burdensome this is for physicians, but we just need to get to the other side of it,” he said. “My hope is that I can play a part in making sure [the transition] is as painless as possible.”

Physicians may send technical questions to ICD10_ombudsman@cms.hhs.gov. Rogers may be reached at 202-413-9961.

Steph Weber is a freelance writer hailing from the Midwest. She writes about healthcare, finance, and small business, but finds her passion for the medical field growing in sync with the ever-changing healthcare laws.