The usual suspect

ICD-10 will probably be in the news every week up until the Oct. 1 transition and perhaps even more often after that, depending on how it goes.

The American Medical Association and 99 other professional organizations expressed their concerns about just that this week to the Centers for Medicare & Medicaid Services (CMS). The agency needs to improve ICD-10 transition plans 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, they said.

Pointing to the recent end-to-end testing effort, the groups said 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.

“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. 

Are these legitimate concerns or is this the latest attempt by the AMA to thwart ICD-10?

Beth Walsh

Clinical Innovation + Technology editor