Is ICD-10 even realistic?

That’s a question that was never properly answered. HHS has simply mandated that the industry do this, without effectively investigating whether or not transitioning to ICD-10 is even realistic for the small and mid-size providers who serve 74 percent of the whole population. ICD-10 challenges, however, are many and multi-faceted. Beyond training and implementation, they grow deeper and more complex, some with dire consequences: workforce, fraud, waste and abuse, sustainability, mitigation.

Edward Rippel, MD, of Quinnipiac Internal Medicine, P.C, who the NCQA unofficially calls its “triple crown winner” for achieving DRP, HSRP and PCMH as a solo practitioner, said that the top-down, federal mandate approach simply does not work.

“There are doctors saying that the cost of implementing ICD-10 across the country will be astronomical. It appears to be for the purposes of more accurate data capture on the part of individuals who want to do statistical analysis, but it’s coming on the backs of the doctors in terms of costs, workflow change and administrative problems,” Rippel said. “Once you start changing to a whole different coding system, providers will have to be re-educated on how to code for their services. It’s a universal system and they want to make everybody change – at our cost. In the end, who really benefits? Are the patients going to benefit from this? I don’t see it.”

Hold fire, for now
In the meantime, CMS remains steadfast that October 1, 2013 is a firm deadline and there will be no further delays. But with the healthcare industry currently in the middle of ICD-10’s EDI pre-cursor, HIPAA 5010, and its 90-day enforcement-free grace period, CMS has earned praise for being pragmatic enough to recognize the damage inflexibility might have wrought with 5010.

Just how well that transition is actually going, though, well that depends on whom you ask. While some would say that their advance preparation is already paying off, the fact is that claims are being rejected, be that due to payers being stricter than with 4010, extraneous information with 5010, taxonomy code requirements, or the number of procedure codes that necessitate a description, as ICD10Watch Editor Carl Natale reported last week.

Contending that the 5010 conversion “is not working and is choking the cash flow of many of its members,” MGMA last Wednesday called on HHS Secretary Sebelius to not only extend the HIPAA 5010 enforcement-free period until June 30, during which covered entities could submit 4010 claims, but also instruct MACs to provide advance payments to physician practices having difficulty with 5010, allow MACs to accept claims that do not include all the requisite 5010 data, expedite adjudication of paper and electronic claims, monitor readiness level in the industry, among others. 

“One thing we are watching for is the industry transition to HIPAA 5010,” MGMA’s Tennant explained. “Smooth or protracted implementation of 5010 will be a good gauge for how ICD-10 will go.”

Whether the AMA gains allies against AHIMA or falters alone like John Brown’s band at Harper’s Ferry (though with less dire circumstances) remains to be seen, of course.

But last week’s ICD-10 skirmish will not likely be the end of anything.