AMA calls for ICD-10 backup plan

As there have been multiple delays for ICD-10 implementation over the past few years, the American Medical Association recently wrote a letter to the Centers for Medicare & Medicaid Services asking it to make preparations for a possible ICD-10 failure. The association and 99 additional physician organizations requested that the CMS provide contingency plans in case the upcoming transition date falls through. 

AHIMA eases concern over possible ICD-10 failure 
The CEO of the American Health Information Management Association, Lynne Thomas Gordon, responded in a publication by Health Leader's Media to the concern expressed by the AMA, explaining that there is no reason for physicians to feel worried about the coming ICD-10 transition. 

She cited the most recent ICD-10 end-to-end testing results, which showed that claims acceptance rates would still remain high at 81 percent. She also noted that the claims that were rejected were a result of factors that were unrelated to ICD-10 mistakes. 

"The letter talks about how only 81 percent were accepted and processed and were not rejected in the January testing," Sue Bowman, the AHIMA's senior director for coding, policy and compliance, told Health Leader's Media. "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 percent of the rejected claims had anything to do with ICD-10. That makes it more like 97 percent if you are looking solely at the ICD-10 risk issues." 

In the AMA's letter, it expresses concern that only 1 in 5 of the claims submitted would be approved. As the CMS is likely to receive millions of claims, this would present a major problem for the industry. To avoid the consequences of such a pitfall, the AMA urged contingency plans to be made and put in place. However, Bowman explained that the chances of this, or any additional large issues, happening are very small and that the comments and concerns from the AMA are unfounded. 

AMA letter may be promising turning point 
Gordon noted that there is a positive aspect to the AMA's letter, despite its remarks of concern. She explained that it shows the physician groups are finally ready to start the transition to ICD-10 in October after years of complaints.

Instead of focusing on influencing the federal government to push the implementation date back, they have started to acknowledge that there will not be another delay and that preparations for potential issues should be taken care of. The number of providers who are on board with the Oct. 1, 2015, date is beginning to increase and will likely continue to do so over the coming months, accelerating the movement toward how the industry will deal with the new coding system once it replaces ICD-9. 

EHR Intelligence explained that the Medicare program already has a policy that allows accelerated payments, which are offered when a physician practice or hospital has a temporary delay in their payments during the billing cycle.

The AHIMA said that the AMA's worry over unpaid Medicare claims is one that should be taken seriously, despite the low chances it will actually occur. The association is planning to develop contingency plans as the AMA and physician groups have requested, but this does not change anything about the implementation date.

Providers should take advantage of the many resources created for those who need to catch up on ICD-10 integration and become more familiar with the ICD-10 coding system. In its response, the AHIMA's main goal was to make it clear that the deadline is not expected to be pushed back any further, regardless of whether or not contingencies are developed.