AMA Renews Call for ICD-10 Contingencies

John Commins, June 24, 2015

A hardship exemption is needed for physicians who've tried in good faith to meet the Oct. 1 implementation deadline, but who've been hamstrung by issues beyond their control, says the president of the American Medical Association.

Less than 100 days before the federally mandated switch to the ICD-10 diagnostic code, the American Medical Association is renewing its call for contingency plans to ensure that physicians struggling to meet the Oct. 1 implementation are not unfairly penalized, nor care disrupted.

"This transition to ICD-10, if it goes forward on Oct. 1, and that appears to be the current trajectory, [means] it is absolutely imperative that there is better end-to-end testing, a grace period, and hardship exemptions in place," says recently elected AMA President Steven J. Stack, MD.



Steven J. Stack, MD

Stack says the AMA has also called on Health and Human Services Secretary Silvia M. Burwell to exercise her prepayment authority "to ensure that claims get paid on a timely basis in those first weeks and months, and then as we navigate those early days of the transition so that the care system is not brought to a halt as hundreds of thousands of claims per day could potentially get disrupted."

Stack says physicians are not necessarily assuaged by assurances from the Centers for Medicare & Medicaid Services and ICD-10 advocates that sufficient testing is underway for the diagnostic code set that will replace ICD-9.

AMA Delegate Blasts ICD-10 Implementation Requirements

"Our major concern is that it is a 400% or so explosion in the number of codes," he says. "It's being treated like a flip-the-switch activity, where on Sept. 30 we use ICD-9 and on Oct. 1 one-fifth of the nation's economy is supposed to just on one day switch to an entirely new coding set that is over a 400% increase in the total number of codes."

"This fails to take into consideration that physicians are being compelled to do this at the same time that they are being compelled to do multiple different quality reporting programs, let alone all the private payer quality reporting programs," Stack says.

A survey of more than 800 providers released in March by the Workgroup for Electronic Data Interchange, found that only 25% of respondents had begun external testing of their ICD-10 capacity, a decrease from the 35% of providers who'd begun external testing in August, 2014.

However, the WEDI survey also found that the biggest hurdle was not so much the complexity of the implementation, but more the uncertainty around the Oct. 1 implementation date, which has already been delayed three times at the behest of the AMA and other provider associations.

"While the delay provided more time for the transition to ICD-10, many organizations did not take full advantage of this additional time and many providers are falling further behind," WEDI ICD-10 Workgroup Co-Chair Jim Daley said in remarks accompanying the survey.

John Commins

John Commins is a senior editor at HealthLeaders Media.

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