100 groups express concern for ICD-10 transition plans

The Centers for Medicare & Medicaid Services (CMS) need to improve ICD-10 transition plans, according to the American Medical Association (AMA) and 99 other state medical, medical specialty and professional associations.

The groups are worried there are not sufficient contingency plans in place to avoid anticipated failures that could result in a significant, multi-billion dollar disruption for physicians and serious access to care issues for Medicare patients.

“By itself, the implementation of ICD-10 is a massive undertaking,” the concerned groups wrote in the letter. “The undersigned organizations remain gravely concerned that many aspects of this undertaking have not been fully assessed and that contingency plans may be inadequate if serious disruptions occur on or after Oct. 1.”

Recently released end-to-end testing results showed that the claims acceptance rate would fall from 97 percent to 81 percent if ICD-10 was implemented today. That change in Medicare’s acceptance rate could potentially cause a catastrophic backlog of millions of unpaid Medicare claims. Because the testing only represents less than one percent of all Medicare claims and likely involved providers who are significantly more prepared for ICD-10 than many of their peers, the acceptance rate could actually be much worse.

“Given that Medicare processes 4.4 million claims per day, even a small change in this acceptance rate will have an enormous impact on the system and payment to physicians,” read the seven-page letter to CMS acting Administrator Andrew Slavitt. “The likelihood that Medicare will reject nearly 1 in 5 of the millions of claims that go through our complex healthcare system each day represents an intolerable and unnecessary disruption to physician practices,” AMA President Robert Wah, MD, said in a release accompanying the letter. “Robust contingency plans must be ready on day one of the ICD-10 switchover to save precious healthcare dollars and reduce unnecessary administrative tasks that take valuable time and resources away from patient care,” Wah said. 

The group also urged the CMS and the Office of the National Coordinator for Health IT to look into whether EHR system developers, who have been delayed in upgrading their systems to the more stringent 2014 Edition requirements for the EHR incentive payment program, will be experiencing similar delays with converting their systems to ICD-10.