Are You Ready for ICD-10?

The Oct. 1 compliance date to transition to ICD-10 will be here before you know it. A January report from the Medical Group Management Association (MGMA) suggests physicians, payers, and electronic health record (EHR) vendors are all well behind the curve in preparing for implementation.

The report shows fewer than 10 percent of responding practices had made significant progress when rating their overall readiness for ICD-10 implementation. Only 8.2 percent had begun or completed testing with their EHR vendor, and nearly 60 percent of respondents stated they hadn't heard from their major health plans as of December regarding when ICD-10 testing would begin.
On top of that, a new AMA-commissioned cost study says the costs for physician practices to implement the federally mandated transition to the ICD-10 code set are three times earlier estimates.  
 
Using the new report as ammunition, AMA "strongly urged" U.S. Health and Human Services Secretary Kathleen Sebelius to "reconsider the mandate." 
 
The study, conducted by Nachimson Advisors, compared current estimates of ICD-10 conversion with Nachimson's 2008 report. For a typical small practice, the costs increased from $83,290 in 2008 to a range of $56,639 to $226,105 in 2014. Costs for a typical large practice jumped from $2.7 million in 2008 to a range of $2 million to $8 million this year.
 
The Centers for Medicare & Medicaid Services (CMS) mandated the ICD-10 diagnosis code set for use by physician practices, other practitioners, clearinghouses, and health plans. With ICD-10 containing more than five times the number of codes as ICD-9 and incorporating a completely different structure, the new code set will require extensive changes for medical groups.

On Feb. 19, the federal government agreed to conduct limited end-to-end testing on ICD-10 for a small sample group of health professionals selected to represent "a broad cross-section of provider types, claims types, and submitter types."

"End-to-end testing includes the submission of test claims to [the Centers for Medicare & Medicaid Services] with ICD-10 codes and the provider's receipt of a Remittance Advice (RA) that explains the adjudication of the claims," CMS said in a memo to health professionals.
 
American Medical Association President Ardis Dee Hoven, MD, says that while the decision to conduct end-to-end testing pleases AMA, the association "continues to urge CMS to reconsider the ICD-10 mandate during a time when physicians are struggling to keep up with many other costly, federal mandates."

At the AMA House of Delegates meeting in June, TMA delegates directed AMA to support federal legislation to "stop the implementation of ICD-10 and remain with ICD-9 until ICD-11 can be properly evaluated." Although TMA opposes the transition to ICD-10, the association has many tools and resources to help you get ready for the new coding system, should CMS persist in its current trajectory.

  • TMA's newest statewide seminar series, ICD-10 Documentation and Auditing: Success Is in the Details, delves into how to use the new ICD-10-CM code book and its guidelines and how to audit physician documentation in day-to-day practice. 
  • ICD-10 Now! How and Why, an on-demand webinar from TMA, offers a detailed look at everything you need to know and do to prepare for ICD-10. TMA's on-demand webinar ICD-10 Starts With Physicians targets physicians, office managers, and coders. It highlights the ICD-10 transition process, code structure, and the impact of ICD-10 on a practice. Register for the webinars online.
  • Be sure to bookmark TMA's ICD-10 resource page for news, tools, education, updates, and the ICD-10 Readiness Questionnaire for Vendors from the American Health Information Management Association.
  • The TMA Knowledge Center alert service will also keep practices up to date with the newest articles and latest developments on ICD-10 and other health care topics. TMA Knowledge Center staff have created custom searches on ICD-10 and many other topics set to run weekly. The search can be emailed directly to you or accessed via RSS feed. TMA Knowledge Center alerts provide citations and abstracts along with some full-text access. Fill out the online form to sign up.

Action, March 3, 2014

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