AMA, Obama Administration Battle Over ICD-10

By John Oncea, Editor

Follow John on Twitter: @buck25

The American Medical Association wants the ICD-10 transition deadline extended - or at least some enforcement concessions made - while the Obama administration is firm in its insistence that it will stay as is. Who will blink first?

During its Annual  Meeting, delegates to the American Medical Association (AMA) “voted to mandate a two-year implementation period for ICD-10/11, during which time insurers would not be allowed to deny payment based on the specificity of an ICD-10/11 diagnosis” according to AMA Wire. The desired outcome is for Congress and Medicare to require health insurers give physicians flexibility following the October 1, 2014 change from 16,000 to 140,000 diagnosis codes.

Jasmine Pennic of HIT Consultant writes of the AMA’s mandate, “During this proposed grace period, payers should not be allowed to deny payments to physicians for all ICD-10 coding errors and should be required to provide feedback on why claims were denied.” Pennic further notes, “According to coding experts, nearly 65% of clinical documentation  does not contain enough information for coders to use for billing, which further complicates the ICD-10 transition since most doctors do not provide enough detail for office coders to translate that to ICD-10.”

Or, as Gene Marcial writes in a contributed article to Forbes, “If you think the issue of healthcare is already a big source of confusion, wait till medical providers try to divine the new diagnostic codes” which “may turn out to be more complex than the Da Vinci Code.”  Marcial details earlier attempts by the AMA to delay implementation of the new codes, referencing an article by fellow Forbes contributor Bruce Japsen detailing one such instance.

Japsen’s article describes a letter to the Obama administration signed by more than 40 doctors groups urging it “to stop the new coding system, saying it would cause additional financial pressures on doctor practices, particularly smaller physician offices already getting hit hard by the costs of implementing electronic health records.” However, both Japsen and Marcial write there are no plans to delay or cease implementation.

Japsen points out, “The conversion to ICD-10 was already delayed a full year from October of this year when it was originally scheduled to be implemented.” Marcial quotes Dr. Farzad Mostashari, national coordinator for healthcare IT in the Obama administration, as asserting “in a keynote address in mid-June at the HIMSS Media ICD-10 Forum in Maryland, that ‘there would be no more extension of the deadline for switching from the ICD-9 medical coding system to the ICD-10.’”

The repeated denials by the Obama administration to further delay the switch to ICD-10 haven’t dissuaded the AMA in its’ attempts to at least get it to make concessions. A week prior to the Annual Meeting, AMA Executive Vice President and CEO James Madara, MD sent a letter to Health and Human Services Secretary Kathleen Sebelius “on behalf of the physician and medical student members of the AMA (urging her) to find ways to mitigate the impact of the ICD-10 transition on practicing physicians.” Madara goes on to suggest seven “ideas on ways to help offset this costly change” as follows:

• retool Medicare’s “advance payment policy”
• commit Medicare to reducing the number of requests for additional information/attachments
• mandate uniform set of payment rules and edits
• Medicare pilot test X12 standards to achieve more efficient use of prior authorization
• utilize the Regional Extension Centers (RECs) to help educate and train physicians on ICD-10
• adopt coding guidelines for all HIPAA-adopted code sets
• mandate claims acknowledgments

Despite the attempts of the AMA and other groups to delay ICD-10, Ken Terry of InformationWeek Healthcare suggests they prepare to be disappointed. Terry quotes Edward Hock, a director of the Advisory Board Co., a Washington, D.C.-based consulting firm, as saying “While the Centers for Medicare and Medicaid Services (CMS) is unlikely to allow a train wreck, there's nothing that would lead organizations to believe they should not be prepared to the fullest for ICD-10 by October 2014."

Terry further quotes Hock as saying “he believes that by the end of this year, far more healthcare organizations will be engaged in preparing for ICD-10. ‘We're seeing more and more organizations tackle this more seriously than at any point yet (and) that increased attention will accelerate between now and the end of the year, as well as between now and the transition.’"

Hock told Terry physician practices need to be concerned, “But if they turn to ICD-10 pretty seriously over the next six months -- which we're beginning to see happen -- they can be well set up for success prior to the transition."

Health IT Outcomes Editor In Chief Ken Congdon offers additional tips to healthcare providers as they prepare for the inevitable switch, writing, “As ICD-10 transition plans intensify, providers are becoming keenly aware of their own ICD-10 readiness, or lack thereof. The following are tips to ensure your organization doesn’t fall victim to common ICD-10 pitfalls.” Among the tips listed by Congdon are accessing system readiness/impact, investing in the appropriate technologies, and implementing education and training.

Dan Vogt of Mondaq offers tips of his own on transitioning successfully to ICD-10, writing, “We caution you to watch out for some possible issues that could complicate your execution of the transition process,” listing a lack of granularity, relying too much on vendor’s statements of readiness, and not engaging in enough planning, testing, and communication with payers and partners as three potential downfalls. Vogt – looking for the silver lining – concludes, “ICD-10 is a compliance initiative with a fast-approaching deadline, but it's also an opportunity to assess and improve the communication and practices across your whole organization.”