CMS Announces Limited ICD-10 Claims Testing
News that the Centers for Medicare and Medicaid Services (CMS) will offer a rigorous, four-pronged approached to ICD-10-CM/PCS (ICD-10) preparedness and claims testing for fee-for-service providers was welcomed by panelists at a federal health subcommittee hearing Wednesday.
At a hearing held by the National Committee on Vital Health Statistics Subcommittee on Standards (NCVHS), an advisory body to the US Department of Health and Human Services , CMS officials said the agency would begin end-to-end test claims with ICD-10 codes starting this summer for a small sample group of providers.
The testing will include submission of test claims to CMS with ICD-10 codes and the provider’s receipt of a Remittance Advice (RA) that explains the adjudication of the claims. The sample will include a cross-section of provider types, claims types, and submitter types, according to the CMS newsletter MLN Matters.
The other three components to CMS’s readiness plan includes CMS internal testing of its claim processing systems, provider-initiated beta testing tools, and acknowledgement testing.
ICD-10-CM/PCS Readiness a Mixed Bag
Hearing panelists, which included Meryl Bloomrosen, MBA, RHIA, FAHIMA, AHIMA’s vice president of thought leadership, practice excellence, and public policy, and representatives from the American Medical Association (AMA), the American Hospital Association (AHA), Humana, Emdeon, and others, applauded the news, noting that stakeholder groups have been calling on CMS to offer such testing for quite some time.
The hearing, titled “ICD-10: Achieving a Successful Transition,” addressed lingering industry concerns about ICD-10 implementation and readiness, as well as private and public solutions for preparation.
While panelists on the provider and the payer side expressed a mix of optimism and concern, panelists and CMS officials agreed that the October 1, 2014 deadline must not—and would not be moved.
George Arges, senior director, AHA, urged “the entire community to stop debating ICD-10 and take action to support implementation,” noting that a recent AHA study found that the vast majority of hospitals will be ready for the transition.
Bloomrosen said she welcomed CMS’s end-to-end testing program and made note of the AHA’s readiness study, adding, “In terms of studies, I’m not sure there’s agreement on what readiness means. There’s a gut feeling that we’ll know it when we see it,” Bloomrosen said.
She also added that ICD-10 transition challenges AHIMA has identified include areas such as coder education, clinician education, workforce shortages, and clinical documentation improvement training.
In a written statement submitted with her testimony Bloomrosen said, “EHR [electronic health record] and CAC [computer assisted coding] technologies can be leveraged to automate and improve documentation, coding, data extraction, and ultimately patient care. The effective use of technology as well as other risk mitigation strategies I mentioned earlier will help to ensure that healthcare organizations transition to ICD-10 smoothly, with minimal disruption, and realize the benefits of better healthcare data earlier.”
AMA Resistance to ICD-10-CM/PCS Continues
The American Medical Association, however, has not tamped down its efforts to delay or block ICD-10 implementation. Nancy Spector, the AMA’s director, electronic medical systems, touted a new AMA-sponsored study at the hearing. The study found the costs for the ICD-10 transition will be higher than previous estimates for physician practices.
The cost study compared expected implementation costs from 2008 with those anticipated today. New cost estimates for small physician practices range from $56,639 to $226,105, compared to $83,290 in 2008. Current estimates for large practices range from $2 million to $8 million compared to $2.7 million in 2008, according to the Nachimson Advisors report. The report authors admit that the 2008 estimates were derived prior to the American Reinvestment and Recovery Act (ARRA) of 2009’s financial stimulus to the health IT industry, and “that no actual implementation experience existed” in 2008.
In a letter urging US Health and Human Service Secretary Kathleen Sebelius to reconsider adoption of the ICD-10-CM/PCS code set, the AMA wrote that “Physicians are being asked to assume this burdensome requirement at the same time they are being required to adopt new technology, re-engineer workflow and reform the way they deliver care; all of which are interfering with their ability to care for patients and make investments to improve quality.” The AMA also launched a Twitter campaign encouraging members to Tweet against ICD-10 using the hashtag #StopICD10.
Other healthcare stakeholders are forging ahead with implementation plans and testing. The Massachusetts Health Data Consortium, for example, brings together health plans, providers, vendors, government entities, and IT groups to develop an ICD-10 testing solution that can be tested across the state, according to Medical Practice Insider.
Additionally, the Workgroup for Electronic Data Interchange (WEDI) is working with the Centers for Medicare and Medicaid Services, as well as other private and public partners, including AHIMA, on an ICD-10 Implementation Success Initiative. In addition to creating a searchable database of ICD-10 issues and concerns, the initiative “will help triage issues and provide valuable information and resources to help healthcare organizations understand how the new codes and coding standards will impact diagnosis and inpatient procedures.”