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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Hospital Groups Call for Avoiding Another ICD-10 Delay |

Hospital Groups Call for Avoiding Another ICD-10 Delay | | EHR and Health IT Consulting |
Hospital groups have written a letter to leaders of Congress asking the latter to avoid another ICD-10 delay.

With less than ten months to go before healthcare organizations and providers need to comply with most recent ICD-10 transition deadline, the standoff between proponents and opponents of the 2015 ICD-10 compliance date is increasing in intensity.

A band of hospital and health system associations have written a letter to leaders of Congress asking the latter to avoid another ICD-10 delay. A total of eight industry groups have undersigned the petition:

“As the organizations representing more than 5,000 hospitals and health systems across the country, we strongly support the announced October 1, 2015 ICD-10 compliance date and oppose any steps to delay,” the organizations write. “Recent ICD-10 implementation delays have been disruptive and costly for hospitals and health systems, as well as to health care delivery innovation, payment reform, public health, and health care payment.”

The letter to Representatives John Boehner (R-OH) and Nancy Pelosi (D-CA) and Senators Harry Reid (D-NV) and Mitch McConnell (R-KY) specifically recalls the setbacks resulting from the most recent one-year delay of ICD-10 implementation from 2014 to 2015:

The delay added billions of dollars in extra costs. Many of our members had to quickly reconfigure systems and processes that were prepared to use ICD-10 back to ICD-9. Newly trained coders who graduated from ICD-10 focused programs were unprepared for use of the older code set and needed to be retrained back to using ICD-9. Further, training of existing coders needed to be repeated given the one-year delay. This results in a doubling of costs that are not productive. A further delay would only add additional costs as existing investments would be further wasted and future costs would grow.

The advocacy by the hospital and health system associations comes shortly after Medical Society of the State of New York and Texas Medical Association called on their members to persuade Congress to implement two-year ICD-10 delay until 2017. Those provider association have highlighted the negative financial implications for physician practices if an industry-wide ICD-10 implementation failed on Oct. 1, 2015.  The letter’s timing of December 5 also coincides with the message delivered by the Coalition for ICD-10 following remarks by American Medical Association President Robert Wah, MD, that contained arguments against and jokes about new code set.

Based on the types of organizations working in favor and against an additional ICD-10, a division clearly exists between hospitals and hospitals and physician practices. While advocates for the latter reiterate the readiness of their constituents, their counterparts see nothing bad negative consequences ahead for their members. And this division likely to puts to be any lingering doubts about the forces behind the most recent ICD-10 delay.

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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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