100 Physician Groups Call for Contingency Plans for ICD-10 Transition

The American Medical Association (AMA) and 99 state and specialty societies recently urged the Centers for Medicare & Medicaid Services (CMS) to address several of their concerns about the potential impact of the transition to the ICD-10 code set. The groups are worried there are not sufficient contingency plans in place to avoid anticipated failures that could result in a significant, multibillion dollar disruption for physicians and serious access to care issues for Medicare patients.

Recently released end-to-end testing results showed that the claims acceptance rate would fall from 97% to 81% if ICD-10 was implemented today. That change in Medicare's acceptance rate could potentially cause a catastrophic backlog of millions of unpaid Medicare claims. Because the testing only represents less than 1% of all Medicare claims and likely involved providers who are significantly more prepared for ICD-10 than many of their peers, the acceptance rate could actually be much worse.

"The likelihood that Medicare will reject nearly one in five of the millions of claims that go through our complex health care system each day represents an intolerable and unnecessary disruption to physician practices," says AMA President Robert M. Wah, MD. "Robust contingency plans must be ready on day one of the ICD-10 switchover to save precious health care dollars and reduce unnecessary administrative tasks that take valuable time and resources away from patient care."

The groups are calling for CMS to also consider how the transition to ICD-10 will impact quality reporting programs such as the Physician Quality Measurement System (PQRS) and meaningful use (MU). Because PQRS and MU quality reporting periods are based on the calendar year and the switch to ICD-10 will be occurring more than three quarters of the year in, the quality measures for 2015 will be reported and tabulated with both ICD-9 and ICD-10 codes. This will especially be problematic for measures that capture encounters pre- and postvisit for services that straddle the October 1st transition deadline where physicians will be required to report ICD-9 for the first segment of care and ICD-10 for the final.

"We are concerned the administration is underestimating the impact the transition to ICD-10 will have on the regulatory tsunami that is already burdening physicians and threatening access to quality care," says Wah. "Although we appreciate the training, educational tools, and other efforts by CMS to prepare physicians for the ICD-10 transition, it is clear that more information is needed about how the shift will impact quality reporting so physicians can avoid penalties."

The letter is part of the AMA's ongoing efforts to reduce burdens on physicians so they can focus on providing high-quality care for their patients.

Source: American Medical Association