CMS considers delay on ICD-10 implementation

The Centers for Medicare & Medicaid Services (CMS) is considering whether to delay implementation of the ICD-10 diagnostic code set, according to several news reports. Marilyn Tavenner, acting administrator of the agency, told attendees at an American Medical Association conference Tuesday in Washington, D.C., that CMS intends to reexamine the timeline for the switchover to the new code set. Right now, CMS regulations require all providers to use ICD-10 in administrative transactions starting Oct. 1, 2013. 

The AMA recently asked Congress and the U.S. Department of Health & Human Services to stop implementation of ICD-10. In response to CMS' change of heart, AMA President-Elect Jeremy Lazarus, MD, commented, "The AMA appreciates that Ms. Tavenner and the administration have heard our concerns and have recognized the significant challenges and burdens ICD-10 implementation will create on the practice of medicine, and that they are committed to reviewing the pace of implementation. The AMA welcomes the opportunity to discuss ICD-10 implementation, along with many overlapping regulatory requirements that are burdening physician practices."

Be sure to register for our breakfast panel discussion on ICD-10 preparedness from 7 to 8:30 a.m. on Wednesday, Feb. 22 at the HIMSS conference in Las Vegas. For more information and to register, visit the ICD-10 Readiness for Hospital IT Leaders: Lessons Learned from the Trenches website.

There are indications that the current problems in implementing the 5010 transaction set--a prerequisite for ICD-10--may have played a role in CMS' turnabout. The Medical Group Management Association (MGMA) recently asked CMS to postpone enforcement of the 5010 set to June 30 because so many physicians are encountering payment delays as a result of the transition.

Robert Tennant, senior policy advisor for MGMA, told FierceHealthIT, "We have been very concerned about the implementation strategy adopted by CMS. There has been no pilot test, no funding for physician practices, no true cost-benefit analysis, no established process for moving the industry forward. Without these steps completed, and with the problems we have faced implementing the 5010 transaction set, MGMA does not believe CMS should move forward with ICD-10."

Tavenner reportedly told the AMA representatives that she wanted to reduce the administrative burden of ICD-10 on physician practices. The ICD-10 changeover will increase the number of diagnostic codes from 13,000 to 68,000, requiring additional work for claims coding and documentation. According to the AMA, the transition costs will range from $83,290 to more than $2.7 million.

MGMA has estimated it will cost a 10-doctor practice an average of $285,000 to convert to ICD-10. New software would account for only about $15,000 of that amount, according to an MGMA study. The bulk would be for increases in claims queries, reductions in cash flow, and increased documentation time.

Hospitals also face substantial costs in converting to ICD-10, but the American Hospital Association (AHA) has not joined the physician groups in calling for implementation to be halted or delayed.

Chantal Worzala, director of policy for the AHA, told FierceHealthIT that the association is fielding a survey to find out where its member hospitals stand on ICD-10.

"Our understanding is that some hospitals have invested considerable resources in preparing for ICD-10," she said. "They took the deadline seriously and are well on their way. We also have members who are struggling, given the add-ons of Meaningful Use and health reform. So we're hearing from both ends of the spectrum, and we're trying to get a more holistic picture through our survey."

Worzala pointed out that the AHA agreed to the October 2013 deadline for ICD-10 before the passage of the economic stimulus legislation, which created the Meaningful Use program, and the healthcare reform law. "So the environment has changed a lot since we made that commitment," she said. "And we've been listening very carefully to our members about how they're handling these multiple initiatives. Like the CMS administrator, we want to gather information and look at the timeline and see if it still makes sense."

Worzala added that the 5010 transaction set has gotten off to a rocky start in hospitals and may have taken away some focus and resources from ICD-10 preparations. "We really believe you need a successful transition to 5010 in advance of ICD-10," she said.

To learn more:
- read the Government Health IT article
- see the story from The Hill
- peruse an InformationWeek Healthcare piece about the AMA's position


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