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MGMA: ICD-10 delay would increase time for testing, standards

By Jennifer Bresnick

- Is the potential for an ICD-10 delay a bad thing?  It really depends on who you ask.  While providers who have spent an enormous amount of time and money pulling off the herculean effort of getting fully prepared for October 1, 2014, the new temporary SGR repeal bill that includes language pointing to an extra year for ICD-10, might seem like a slap in the face.  But for the majority of healthcare organizations, twelve more months to get prepped is a dream come true.

HR 4302 has passed the House of Representatives with a voice vote and heads to the Senate, while the healthcare industry is bracing for the bombshell that will explode whether the bill is signed or not. Robert Tennant, Senior Policy Advisor at the Medical Group Management Association (MGMA), thinks a delay might be just the thing the industry needs in order to succeed with the ICD-10 transitions.

“Let me start off by saying that MGMA is aligned with the other physician organizations in opposing HR 4302,” he told EHRintelligence. “We’re looking for a permanent fix of the SGR, which is why we’re not supportive of the bill.  We would all prefer a permanent fix, but due to the timing, it looks like they won’t be able to do that.  So that’s disappointing.  This is probably as good a time as any in the last few years, but it didn’t happen.”

 

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Section 212, however, which states that “the Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD–10 code sets as the standard for code sets,” does not face the same opposition.  The American Medical Association (AMA) has been loudly in favor of additional delays since the beginning of the ICD-10 struggle, and MGMA and other organizations have been adamant that CMS has simply not prepared the industry for the magnitude of the shift.

 

“Right now, our indications are that the key trading partners of practices aren’t ready,” Tennant says.  “Software vendors, both of the practice management systems and the EHRs, aren’t ready. Health plans are simply not in the position to be able to do full end-to-end testing with physician practices or with Medicare.”

“After continually being flogged by MGMA, Medicare finally agreed to do testing, but not sufficiently,” he continued. “They are going to wait until the end of July to conduct their ICD-10 end-to-end testing pilots. And then they’ve got to turn around and get whatever information you gleaned from that test back out to the industry in time to do something with it. Should we get an additional year, obviously we are going to be strongly urging CMS to take advantage of the additional time and open up end-to-end testing with whoever wants to do it. Let’s get that information back out there so we can get that feedback loop going, so providers can be ready should the date be October 1, 2015.”

But is an extra year really fair to providers who have been pulling out all the stops to get ready for a deadline that is less than six months away?  Not even Dr. Ardis Dee Hoven, President of the AMA, can truly say yes.  “That’s a difficult question to answer.  Is it fair?  Probably not,” Hoven admitted in February. “But going forward, you’ve got to correct the losses; you’ve got to make the changes that are necessary.”

Tennant agrees.  “There is no win across the board,” he states. “If they delay it, then those folks that are ready and that do agree with the change and want it…well, they’re not going to be happy.  But the reality is that we have to keep the healthcare system working.  And if you keep a hard date and the system fails, then that’s simply unacceptable.  The most important thing, at least in my mind, is that the claims continue to get paid and patients are seen.”

A delay would also give time for WEDI and EHNAC to boot up their practice management certification program, Tennant added.  “Up until now, we’re have no accreditation or certification process in place for the type of software practices use to generate claims and other types of transactions.  So the goal is to accredit the fact that the software can not only produce the transactions, but can produce a compliant 837 claim with an ICD-10 code.  It’s a wonderful opportunity not just for ICD-10, but in general, for practices to know that when they spend a large amount of money on a piece of software, it actually does what it needs to do.”

A delay would also ease the timeline for software vendors who have been struggling to push their products through the ONC’s 2014 edition certification criteria, and for providers who are planning to make the jump to Stage 2 of Meaningful Use in the next few months.  It hasn’t been an easy road, and providers have been complaining that they simply don’t have the software they need in hand to make the switch.

“Only a tiny percentage of software products have been recertified for 2014,” Tennant points out.  “Well, for the most part, those are the same vendors that need to produce an ICD-10 fix.  So if they’re not ready for Stage 2 and the 2014 criteria, they’re probably not ready for ICD-10.  The main players probably will be, but many, many practices use small vendor products that simply will not provide for ICD-10 codes come October 2014,” he said.  “By giving the industry an accreditation process, it puts some market pressure on the vendors to conform to standards, and also, it gives purchasing confidence to the practices.”

While increased confidence, a greater opportunity for testing, and a longer lead-up time may be in the industry’s best interests, CMS will need to do a serious reshuffle if the date is extended despite its best efforts.  Will the ICD-10 delay, tacked on to the larger issue of SGR reform, survive the Senate and head to the President’s desk?  Stay tuned to EHRintelligence for the latest updates on this critical vote.

 

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