Physicians' ICD-10 Fears Unfounded, Says AHIMA

Doctors' shift in focus away from trying to delay ICD-10 again and toward addressing any hiccups with the inevitable transition is seen as a positive sign by AHIMA executives.

The call by 100 physicians' societies across the nation for a backup plan if snafus snarl the scheduled ICD-10 rollout in eight months suggests that doctors are reconciled to the Oct. 1 start for the diagnostic coding set, the leader of one health information technology trade group says.

The American Medical Association and 99 state and specialty societies, in a March 4 letter to Centers for Medicare & Medicaid Services Acting Administrator Andrew Slavitt, express concerns that no contingency plans are in place to avoid failures that could result "in a significant, multi-billion dollar disruption for physicians and serious access-to-care issues for Medicare patients."

Lynne Thomas Gordon, CEO of the American Health Information Management Association (AHIMA), says the fears are understandable, but unfounded, and she calls the letter "encouraging" because it shows that physicians are willing to go forward with the twice-delayed Oct. 1 start up.

"It shows me that they are saying 'We know we are going live Oct. 1. Now, what do we need to worry about?' In that respect, the letter is positive," Thomas Gordon says.

House Members Mull October ICD-10 Launch at Hearing

Sue Bowman, AHIMA's senior director for Coding, Policy and Compliance, says physicians' focus has turned from delaying the ICD-10 start to addressing any hiccups with the inevitable transition.

"The risks of any major problems are pretty small," Bowman says. "Granted, the risk of something is never at zero, but I am not sure if they are mostly worried about physicians not being ready or CMS not being ready."

Concerns Over Claims
In their letter to Slavitt, the physicians' societies raised concerns that recent end-to-end testing conducted by CMS on ICD-10 showed that claims acceptance rates would fall from 97% to 81% if the code set launched today. The societies said such a drop represents a backlog of millions of dollars in unpaid Medicare claims that could badly strain the finances of physician practices that are already contending with a "regulatory tsunami."

"The likelihood that Medicare will reject nearly one in five of the millions of claims that go through our complex healthcare system each day represents an intolerable and unnecessary disruption to physician practices," AMA President Robert M. Wah, MD, said in a media release accompanying the letter.

"Robust contingency plans must be ready on day one of the ICD-10 switchover to save precious healthcare dollars and reduce unnecessary administrative tasks that take valuable time and resources away from patient care."

Contingency Plans
Bowman says that end-to-end testing that CMS conducted in January demonstrates that the government is "definitely ready."

"The letter talks about only 81% were accepted and processed and were not rejected in the January testing," Bowman says. "What is not said is that if you read the testing results the vast majority of the erroneous claims had nothing to do with ICD-10. They were the wrong codes or NPI information. Only 3% of the rejected claims had anything to do with ICD-10. That makes it more like 97% if you are looking solely at the ICC-10 risk issues."

As for contingency plans, Bowman says AHIMA doesn't object as long as those plans "are not used as an excuse not to get ready for ICD-10."

"There are plenty of resources and training out there for all physicians to get up to speed in time for Oct. 1," Bowman says. "That said, we have no objections to the idea of advanced payments as a last-ditch safety net in case there are particular issues with the transition, either the provider end or CMS's end."

Bowman says Medicare already provides for accelerated payments "when a provider has incurred a temporary delay in the billing process, causing financial difficulties for the provider."
"That sounds like exactly what we are talking about," she says. "I am not sure they need to do anything special for ICD-10."