EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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AMA Urges CMS to Provide Backup Plans for ICD-10 Transition

AMA Urges CMS to Provide Backup Plans for ICD-10 Transition | EHR and Health IT Consulting |

What would happen to a medical practice that has one in five of its Medicare claims not properly processed by the Centers for Medicare & Medicaid Services (CMS)? It could lead to a serious financial disruption and strain the budgets of most medical facilities. However, this is just the scenario that could occur on Oct. 1, 2015 when the country carries out the ICD-10 transition if CMS does not develop suitable contingency plans.

The American Medical Association (AMA) and 99 other specialty groups from around the country called for CMS to develop contingency plans for the anticipated failures once the nation transitions to the ICD-10 code set, according to an AMA press release.

The impact to the healthcare sector upon ICD-10 implementation could be severe, leading to a multi-billion dollar disruption and significant access to care problems for Medicare patients. The latest end-to-end testing results show that the Medicare claims acceptance rate would decline from 97 percent to just above 80 percent if ICD-10 implementation occurred today.

Even this percentage on its own could lead to an accumulation of millions of unpaid Medicare claims, which would severely damage the financial outlook of the healthcare industry. However, since the end-to-end ICD-10 testing only speaks for about 1 percent of all Medicare providers, the acceptance rate in actuality may be lower, depending upon how prepared the country is for the ICD-10 transition by October 1.

“The likelihood that Medicare will reject nearly one in five of the millions of claims that go through our complex health care system each day represents an intolerable and unnecessary disruption to physician practices,” AMA President Robert M. Wah, M.D., said in a public statement. “Robust contingency plans must be ready on day one of the ICD-10 switchover to save precious health care dollars and reduce unnecessary administrative tasks that take valuable time and resources away from patient care.”

Along with creating contingency plans, the AMA and other groups are asking CMS to consider how the ICD-10 transition will impact the Physician Quality Reporting System (PQRS) and meaningful use requirements.

The reporting periods for both meaningful use and PQRS will take place more than three-quarters into the calendar year, which means the 2015 reporting data will use both ICD-9 and ICD-10 codes. This will be especially confusing for providers that are treating patients for the same condition right before and right after the October 1 deadline.

The AMA President Dr. Wah continued by explaining that the federal government may be “underestimating the impact” of ICD-10 implementation on providers that are already being encumbered by the many healthcare regulations currently in place. The AMA is focused on reducing burden on physicians and ensuring enough information is given regarding the effects of the ICD-10 transition. A major goal of the AMA is to confirm physicians are able to avoid Medicare payment penalties.

A total of 100 physician groups are asking CMS to provide contingency plans for the anticipated issues of the ICD-10 transition. Having plans in place can help avoid the potential backlog of millions of unpaid Medicare claims once ICD-10 implementation occurs.

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New Calls for Meaningful Use Reporting Changes, ICD-10 Delay |

New Calls for Meaningful Use Reporting Changes, ICD-10 Delay | | EHR and Health IT Consulting |
HIMSS is seeking less stringent 2015 meaningful use reporting requirements while the Medical Society of the State of New York is petitioning for another ICD-10 delay.
While one industry association is calling on its members to support legislation that would make changes to 2015 meaningful use reporting, another is urging Congress to consider legislating an additional two-year delay for ICD-10 compliance.
As first reported by the Journal of AHIMA, the Medical Society of the State of New York began passing around a letter to members of Congress asking to delay the ICD-10 transition until October 2017 “in order to allow for physicians to work thru the myriad of new government regulations that face us.”
The provider association has highlighted the financial implications of a failed industry-wide ICD-10 implementation on Oct. 1, 2015.
“The onerous penalties tied to these mandates add to the hysteria that is running through physicians’ offices and is generating many early retirements,” the letter states. “If every entity in the complex medical payment pyramid does not function perfectly on October 1, 2015 then physicians’ income goes to zero which is a steep price to pay for a new imperfect coding system.”
The medical society is calling on members of the House Energy and Commerce Committee to include the two-year delay as part of “must pass piece of legislation during the upcoming Lame Duck Session in 2014.”
The move by the Medical Society of the State of New York mirrors that of the Texas Medical Association, which is advocating for a similar two-year ICD-10 delay.
Also calling for legislative action is HIMSS which has put out a message to its members to contact their representatives in Congress about the Flexibility in Health IT Reporting (Flex-IT) Act of 2014. The bill (HR 5481) introduced in September by Representatives Renee Ellmers (R-NC) and James Matheson (D-UT) would replace the full-year reporting for meaningful use in 2015 with a quarterly one.
HIMSS, which supports the bill, is looking to galvanize support among its constituents. “Members of Congress are not hearing from their constituents about 2015 Meaningful Use Reporting Period and that is where you can help! HIMSS is engaged in an effort to let members of Congress hear from their constituents about this important issue.”
Falling short of the bill’s passage, the industry association foresees the potential for Congress to consider other legislative avenues in the future. “Even without this bill passing, with enough Congressional support CMS may be persuaded to change the current policy,” the group maintains.
This legislation also has the support of the College of Healthcare Information Management Executives (CHIME), which has repeatedly called on the Centers for Medicare & Medicaid Services to reconsider meaningful use requirements in 2015 just as the federal agency showed a willingness to do in 2014.
“The misstep by officials to require a full-year of reporting using 2014 Edition certified EHR Technology (CEHRT) in 2015 puts many eligible hospitals and physicians at risk of not meeting Meaningful Use next year and hinders the intended impact of the program,” the organization stated in September. “To date; only 143 hospitals have met Stage 2 to date, representing a very small percentage of the 3,800 hospitals required to be Stage 2-ready within the next 14 days.”

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It's not too early to start hating ICD-11 coding

It's not too early to start hating ICD-11 coding | EHR and Health IT Consulting |

Just in case you were wondering, ICD-11 will not be a substitute for ICD-10 implementation. Joyce Frieden reminds us that ICD-11 is expected for release in 2017.

Note that an ICD-11 release doesn't mean it's good to go. Release means healthcare professionals can start reviewing it and learning it.

Since it's supposed to be based upon ICD-10-CM, there will be plenty for U.S. healthcare organizations to complain about. So there will be tweaking.

And of course there will be the campaign to delay ICD-11 implementation because ICD-12 coding will be so much better.

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