Anesthesia Billing & Management

The American Medical Association is doing what it can to halt implementation of the ICD-10 code sets. They are doing so by sending a letter to Health and Human Services Secretary Kathleen Sebelius.

Signed by AMA executive vice president and CEO James Madara, M.D., the letter also asks Sebelius to reexamine penalty timelines associated with multiple Medicare health IT initiatives that are underway.

“The timing of the ICD-10 transition that is scheduled for October 1, 2013, could not be worse as many physicians are currently spending significant time and resources implementing electronic health records into their practices,” says Madara.

Madara points out that adoption of the ICD-10 codes is an unfunded mandate that will cost medical practices between $83,000 to $2.7 million to implement (depending on their size). He also invoked President Obama’s executive order that calls for federal agencies to reassess and streamline regulations.

“This is a perfect opportunity for HHS to make good on its commitment to improve the regulatory climate for physicians,” says Madara.

Madara noted that physician investments in government-sponsored EHR meaningful use, electronic prescribing and quality reporting programs coincide with falling Medicare payment rates and tough penalty programs for failing to comply.

“Physicians are being required to meet separate requirements under these three overlapping health IT programs and have been and will be unfairly penalized if they decide to participate in one program over the other.”

Madara had just issued a similar appeal to House Speaker John Boehner.

The Centers for Medicare & Medicaid Services announced last month that it will delay its requirement for the adoption of a more-robust set of claims transmission standards.

Originally, the switch the ASC X12 Version 5010 standards required of hospitals, physician practices, health plans and claims clearinghouses was set for January 1, 2012. But the CMS announced it would push it back to March 31, 2012.

The announcement came after a significant amount of protest within the medical industry and their inability to be ready to make the upgrade from the Version 4010 standards currently in use. The CMS respond accordingly.

According to the CMS, its decision to push back their enforcement deadline was “based on industry feedback revealing that, with only about 45 days remaining before the January 1, 2012 compliance date, testing between some covered entities and their trading partners has not yet reached a threshold whereby a majority of covered entities would be able to be in compliance by January 1.”

The switch to the Version 5010 standards is consider a necessary precursor to adoption of ICD-10. Those who do not comply by the deadline face hefty penalties. According to the CMS website, “The HIPAA legislation permits civil monetary penalties of not more than $1.5 million per calendar year for a violation of an identical provision.”

According to a Medical Group Management Association member survey, only one in 50 physician group practices has completely implemented the software changes  that are necessary to make the switch to Version 5010.

Medical professionals already have their hands full with healthcare reform, they don’t have ample time or resources to comply to changes that come with ICD-10. That’s, in essence, what The American Medical Association’s House of Delegates is saying in their opposition to the demands associated with the mandatory switchover to the International Classification of Diseases 10th Revision family of diagnostic and procedural codes.

The association voted to “work vigorously to stop implementation” of ICD-10, not only due to healthcare reform, but also the federal push for doctors to adopt electronic health-record systems.

“The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patients’ care,” said AMA President Dr. Peter W. Carmel in a written statement from the association’s nearly week-long policy meeting in New Orleans.

“At a time when we are working to get the best value possible for our healthcare dollar, this massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions,” said Mr.Carmel. “The timing could not be worse as many physicians are working to implement electronic health records into their practices. We will continue working to help physicians keep their focus where it should be – on their patients.”

Without giving a name, the AMA cited a study from 2008 that found that a three-physician practice would spend $83,290 to implement ICD-10, and a 10-physician practice would spend $285,195.

With the Medicare and Medicaid electronic health record initiative, there are incentive payment programs under the American Reinvestment and Recovery Act of 2009 for doctors. However, with the transfer from ICD-9 to ICD-10 there are no funds made available to offset costs.

The deadline for the switch to ICD-10 is October 1, 2013. That date has already been pushed back once. The CMS continues to stand by its stance that they have given healthcare providers enough time to make the transition to ICD-10.

“Implementation of this new coding system will mean better information to improve the quality of healthcare and more accurate payments to providers,” said a CMS spokesman. “We will continue to work with the healthcare community to ensure successful compliance.”