Oct. 1, the ICD-10 transition date, is causing a divide in the healthcare industry between those who are ready and welcoming the change and those who remain hesitant about the coding and billing overhaul.
According to federal agencies, CMS is prepared for the transition that is set to take place in just under seven months. As requested by the Senate Committee on Finance, the Government Accountability Office reviewed CMS' actions to support the transition of covered entities to ICD-10 codes from July 2014 to January 2015 and determined all Medicaid agencies would be able and ready to perform "critical" activities by the transition deadline.
CMS itself has conducted volunteer end-to-end testing, and the first test week resulted in 81 percent of test claims being accepted. The majority of rejected claims were due to non-ICD-10 related errors, such as incorrect health insurance claim number or the dates of service being outside the testing range.
The government appears ready to go, but clinicians and providers are still split on preparedness and enthusiasm to transition.
In a March 3 letter to chairmen and ranking members of the Committees on Energy and Commerce, Ways and Means and Finance, a group of 22 health systems urged against any further delays in the implementation date, writing delays have "penalized organizations that invested significant fiscal, organizational and human resources to prepare for the transition."
The health systems noted that the U.S. remains far behind their counterparts in terms of adopting ICD-10, as many other countries have been using ICD-10 since 1995. The currently used ICD-9 is outdated, obsolete and not consistent with current medical practices, they wrote.
What's more, the government had previously acknowledged the significant monetary ramifications of delaying ICD-10 implementation, the health systems wrote, which would add between 10 and 30 percent to the overall cost for a one-year delay and double that for a two-year delay. "Using the government's own cost estimates from the 2012 delay, our organizations could be penalized by as much as 30 percent of our investment to date with further delays," according to the health systems.
However, not all providers are so eager to transition, notably, the American Medical Association, which consistently expresses its discontentment with government mandates, deadlines and regulations.
One day after the aforementioned letter was sent to members of Congress, the AMA and 99 other medical societies wrote a letter to CMS Acting Administrator Andrew Slavitt expressing concerns with the transition plan. The letter indicates that while CMS testing resulted in claims acceptance rates between 76 and 89 percent, the normal acceptance rate for Medicare claims lies between 95 and 98 percent. "Given that Medicare processes 4.4 million claims per day, even a small change in this acceptance rate will have an enormous impact on the system and payment to physicians," they wrote.
Additionally, the authors expressed concern that timelines for disparate reporting systems may cause problems, largely meaningful use and the Physician Quality Reporting System. While the ICD-10 transition is scheduled to occur in the third quarter of 2015, MU and PQRS' reporting periods are based on the calendar year, so providers will be reporting different codes on either end of the deadline, according to the letter.
"The undersigned organizations remain gravely concerned that many aspects of this undertaking have not been fully assessed and that contingency plans may be inadequate if serious disruptions occur on or after Oct. 1," the letter concludes. "Furthermore, physicians are being asked to assume this significant change at the same time they are being required to adopt new technology, reengineer workflow and reform the way they deliver care, all of which are challenging their ability to care for patients and make investments to improve quality."
While the U.S. is still finalizing plans to transition to ICD-10, the rest of the world already has its eyes set on ICD-11, which the World Health Organization projects will go into effect in 2017.
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