Year in Review: ICD-10 finally happens

Maybe you’re familiar with a little effort called ICD-10 that has been the subject of delays, debate, regulations, contingencies and more for several years now.

Well, this year it finally happened. Despite multiple efforts to scrap the transition or implement yet another delay, ICD-10 was put into use on Oct. 1. After all the controversy, it has been relatively smooth going.

The American Medical Association led the charge during the course of the year with pushes for another delay, then calls for better planning by the Centers for Medicare & Medicaid Services (CMS) and finally working with the agency to establish an ICD-10 ombudsman program and a grace period for claims submission.

In March, AMA and 99 other state medical, medical specialty and professional associations sent a letter to CMS about contingency plans being insufficient 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.”

In May, a bill was introduced that would prohibit the Secretary of the Department of Health and Human Services from replacing ICD-9 with ICD-10. According to Rep. Ted Poe (R-Tex.), sponsor of H.R. 2126, the Cutting Costly Codes Act of 2015, ICD-10 is a “burdensome bureaucratic system” and the transition is having a significant financial impact on physician practices. He cited studies that estimated a range of $56,000 to $8 million in costs. 

In June, the four largest state medical societies called the pending Oct. 1 ICD-10 implementation deadline a “looming disaster.”

That was in response to the news that the most recent end-to-end testing results showed that the claims acceptance rate would fall from 97 percent to 81 percent if ICD-10 then, potentially causing a catastrophic backlog of millions of unpaid Medicare claims.

Most recently, survey results indicate the ICD-10 transition to went smoothly for all but 11 percent of healthcare providers.

“ICD-10 is the healthcare industry’s equivalent to the Y2K changeover in scope and has a profound influence on not only the billing and reimbursement, but the ability to track quality of the delivery of healthcare,” said Todd Ellis, managing director at KPMG. “This is an ongoing process, however, and this transition affects not just technology, but finance, employee training, clinical information and other functions in healthcare.”