D'Arcy Gue

ICD-10: How Will The AMA’s Last Ditch Lobbying Play Out?

June 11, 2015

ICD-10 3 Minute Read

Why are physician practices so vehemently opposed to ICD-10 conversion? It’s a serious problem for the entire industry, with the ICD-10 deadline just over 100 days away.

In the last month the AMA has moved into an aggressive last ditch effort to engineer another respite from ICD-10 for physicians. It has announced its support of one Congressional bill that would kill the ICD-10 initiative outright, and two others that would delay penalties for up to two years following the compliance date. The “penalties” they object to are Medicare/Medicaid claims denials due to coding errors. In other words, if providers submit claims with incorrect coding, the AMA wants them paid anyway over a lengthy “transition period.” It’s hard to imagine the chaos likely to result from this scenario.

Does the AMA expect that commercial payers would follow suit and accept such a transitional arrangement? Will Blue Cross Blue Shield pay claims that are incorrectly coded? It seems highly unlikely.

Physicians continue to complain that an ICD-10 bomb is being dropped upon them, an intrinsically contradictory concept. This bomb has been falling for a long, long time. Let’s face it: ICD-10 has been a major part of the national healthcare reform agenda for several years. Physicians who wanted deadline delays in the past got them – twice – once from CMS and last year from Congress. The new deadline of October 1, 2015 was announced last year; ICD-10 is not a bolt out of the blue.

What is the problem? Physicians don’t want ICD-10. Stated reasons include expected high costs of implementation, poor understanding of the internal changes practices must make, potential disruption in operations and cash flow, and an expectation of little or no benefit resulting from the conversion. Another, more fundamental issue is that physicians don’t like to document; ICD-10 will require more detailed documentation.

As a result, many practices simply have not taken the preparatory steps to start using ICD-10. Nevertheless,  plenty of exceptions exist of  physician practices that have advanced their ICD-10 conversion efforts and expect to be ready for the deadline, according to WEDI’s March ICD-10 Survey. These practices are demonstrating that ICD-10 readiness is neither impossible nor breaking their banks.

Implementation education and support targeted to physician practices have been plentiful. Recognizing that practices have few knowledge resources, CMS and many healthcare organizations have developed and promoted ICD-10 implementation guidelines, tools, Q/A webinars, workshops and more. Much of this support has been free, none prohibitively expensive. Ironically, the AMA and many related physicians’ associations are currently expanding their support initiatives, even as they continue to fight ICD-10 adoption.

While physicians have continued to hope for another reprieve, most hospitals and payers have spent millions of dollars and hours going through the far more complex process of ICD-10 implementation in their organizations – where many systems and departments are impacted. The College of Healthcare Information Management Executives (CHIME), HIMSS,  AHIMA, and many other healthcare associations  strongly support sticking with this year’s October 1 deadline. They have voiced frustration that continued delays are creating ever more costs and operational disruptions for hospitals that are ready to go forward.

The general industry consensus for some time has been that another ICD-10 delay will not occur. Congress as a whole has shown little political will on this issue in 2015. Unfortunately, the renewed brouhaha from physician-based organizations may be rekindling old doubts about the fate of this year’s deadline, including “wait-and-see” attitudes among other healthcare providers. Yet again. Such an attitude swing could be dangerously disruptive during a time when the entire industry should be engaged in a final implementation sprint. Surely and sadly, such an outcome appears to be part of the AMA’s agenda.

For more information about ICD-10, or to seek implementation support, please contact us.

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