AHIMA Responds to Concerns Over ICD-10 Contingency Plans

March 10, 2015 in News

Concerns from a coalition of medical and professional organizations that CMS’ lack of contingency plans for the ICD-10 transition are understandable but unfounded, according to the American Health Information Management Association, HealthLeaders Media reports (Commins, HealthLeaders Media, 3/9).

Background on ICD-10 Concerns

U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures by Oct. 1.

Last week, a group of 100 organizations — led by the American Medical Association — sent a letter to CMS acting Administrator Andy Slavitt over concerns that CMS has not fully addressed several aspects of the “massive [ICD-10 transition] undertaking” and called on the agency to revamp its plans for the ICD-10 transition.

In addition to developing contingency plans for problems that arise on or after the Oct. 1 deadline, the groups called on CMS to release more detailed results from the Jan. 26 to Feb. 3 testing period, during which CMS accepted 81% of claims (iHealthBeat, 3/5).

Details of AHIMA Comments

AHIMA CEO Lynne Thomas Gordon said that the coalition’s letter overall was “encouraging” because it showed that physicians are still aiming to meet the Oct. 1 deadline.

Specifically, she said the letter showed that physicians “are saying, ‘We know we are going live Oct. 1. Now, what do we need to worry about?’”

Meanwhile, Sue Bowman — director of coding, policy and compliance at AHIMA — noted that physicians are shifting their focus from further delaying the transition to addressing any problems.

Bowman also said that contrary to some concerns, CMS’ most recent testing period shows that the agency is “definitely ready” for the transition, noting that the group’s letter did not explain that the “vast majority of the erroneous claims had nothing to do with ICD-10.”

She added that AHIMA does not object to CMS creating contingency plans, but such efforts should not be “used as an excuse not to get ready for ICD-10″ (HealthLeaders Media, 3/9).

Coalition for ICD-10 Argues Against Dual Coding

In related news, the Coalition for ICD-10 in a statement last week denounced the use of dual coding to protect inadequately prepared small physician practices, FierceHealthIT reports (Hall, FierceHealthIT, 3/9).

Dual coding refers to processing both the ICD-9 and ICD-10 code sets in the same time frame. Some groups have called on CMS to permit the practice to provide organizations with some protections.

However, in late February, CMS issued a revised guidance statement saying it would not allow dual coding because most stakeholders have already adopted systems that only use ICD-10 codes starting by the Oct. 1 deadline (Gruessner, EHR Intelligence, 3/9).

In the statement, the Coalition for ICD-10 said permitting dual coding would:

  • Interfere with systems’ ability to accurately analyze costs, outcomes and patient safety;
  • Interfere with systems’ ability to use the same “language” for billing, testing, prescribing and referring;
  • Require complex and costly changes to current payment, clearinghouse and provider IT systems; and
  • Require payment, clearinghouse and provider IT systems that handle claims from multiple providers over time to rewrite systems to allow for mixed ICD-9 and ICD-10 claims (FierceHealthIT, 3/9).

Physicians, Lawmakers Ask Congress for Accommodations

Also in related news, physicians in Congress are urging lawmakers to provide doctors with some accommodations during the ICD-10 transition, CQ HealthBeat reports.

Rep. Andy Harris (R-Md.), who is an¬†anesthesiologist, said that Congress “really should allow some exemptions for practices for whom this is a financial burden.”

Meanwhile, Sen. Bill Cassidy (R-La.), a gastroenterologist, said, “I hope there is wiggle room” related to ICD-10 requirements, noting that the transition could result in reimbursement delays. He said, “There are physicians who are being told to keep six-month’s cash on hand” (Young, CQ HealthBeat, 3/9).

According to Health Data Management, another ICD-10 delay could be included in an ongoing effort to find a permanent fix to the Medicare Sustainable Growth Rate formula. However, no legislation has been drafted yet, according to a spokesperson for Rep. Pete Sessions (R-Texas) (Goedert, Health Data Management, 3/9).

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