New ICD-10 transition period: The healthcare community responds
A subject of debate for several years, the shift to ICD-10 promises great benefits along with the significant burden of increased documentation. However, critics and advocates of the code change may have reached a compromise, following a joint announcement from the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA).
CMS will take four steps to ease the ICD-10 transition for providers for a period of one year, including:
- Not denying claims based solely on code specificity; as long as a code is selected from the appropriate code family, it will not be denied
- Not subjecting physicians to penalties for the Physician Quality Reporting System (PQRS), the value-based payment modifier or meaningful use, as long as they use an ICD-10 code from the correct family of codes
- Authorizing advance payments to physicians if Medicare contractors cannot process claims as a result of problems with ICD-10
- Creating a communication center and appointing an ICD-10 ombudsman to address ICD-10 issues
Does this grace period truly meet the needs of both sides of the ICD-10 debate? Several healthcare organizations and experts spoke out following the announcement — read their opinions below.
“The Coalition for ICD-10 applauds the announcement from the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association concerning their joint efforts to assist physicians prepare for the ICD-10 compliance date. We commend CMS for their efforts to assist small providers with ICD-10 preparations as well as for releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process and help to ease physicians’ transition process.”
“These provisions are a culmination of vigorous efforts to convince [CMS] of the need for a transition period to avoid financial disruptions during this time of tremendous change. These provisions are a testament to the power of organized medicine and what we can achieve when we band together for the good of our patients and our profession.
“These significant improvements for the impending ICD-10 roll-out are just one way our collective voice is helping improve our practice environment for greater practice stability and ongoing quality care.”
Greg Fulton, Greenway Health Government & Industry Affairs Program Manager
“The announcement of a one-year grace period is about peace of mind, and that’s not a bad thing. We know that the April 27-May 1 round of CMS end-to-end testing resulted in only two percent of claims being rejected due to coding errors, so overall I don’t think we’re in for a lot of trouble come October 1. A one-year grace period should have a positive effect on practices that are still unsure of their readiness.
“It’s also a welcome consideration that CMS will not penalize errors impacting quality reporting programs such as PQRS, the value-based modifier and meaningful use. These programs are complicated enough as it is — without the overlapping advent of ICD-10.
“However, we should keep in mind that claims coding impacts healthcare in ways beyond reimbursement. Coding also impacts coverage determinations, validation of medical necessity of healthcare services and quality of care assessments. More reasons to get it right. The sooner things go well, the better.”
“The potential for simple mistakes in classifying one of ICD-10’s thousands of sub-codes could lead to delays in reimbursement and unfair penalties. This could be devastating to smaller provider offices with fewer resources. Physicians in the U.S. are already impacted by several administrative changes affecting the practice of medicine, and we thank you for your efforts to ensure the transition does not unfairly cause burdens and risks to providers.”
Adele Allison, Director, Provider Innovation Strategies, DST Health Solutions
“It is a generous step for CMS considering that the initial regulations that put ICD-10 in motion were finalized under the Bush Administration just as President Obama was taking office in January 2009 — six years ago. The biggest risk to providers is financial, and the ones facing the greatest risk are those with limited resources and capital, such as small or solo practitioners. CMS’s announcement is an effort to mitigate the financial risk that is bound to impact these providers.
“However, it’s important to remember that data capture and reporting will drive providers’ future reimbursement and performance improvements for the sake of the patient — so good data must exist within your technology.
“Every time you submit a claim, you are reporting data to the organization that pays you. If you do not capture specific data, you cannot communicate the nuances of your patient population. This is a cultural problem today, not a technology limitation. Everyone reports that they have sicker, less compliant patients than the next provider, but are you reporting that to your payer through accurate codes?”
Dr. Richard Beane, M.D., Family Medicine of Carthage, Greenway Health customer
“I don’t see this as a major thing — it sounds like CMS is saying they’re not going to fault or penalize providers as long as they’re making some strides toward using ICD-10 coding.
“We were ready for ICD-10 when they said they were going to initially make the transition. I feel that this transition period isn’t discouraging, but rather, just more time to help those physicians that have been procrastinating.
“Some physicians I personally know are just now getting on board with transitioning to ICD-10 within the last 4-6 weeks, and for those providers, they are now not as freaked out as they were when the transition was initially announced.”
AMA, American Association of Orthopaedic Surgeons, American Medical Association, Centers for Medicare & Medicaid Services, CMS, DST Health Solutions, ICD-10, Medicare, Physician Quality Reporting System, PQRS, value-based payment