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Senators confident ICD-10 is a go

It looks like the stars could at last be aligned for ICD-10. After years of angst and multiple delays, comes a government report that indicates the Centers for Medicare & Medicaid have done the necessary testing to move forward.

At least that's how Senate Finance Committee Chairman Orrin Hatch (R-Utah) and Ranking Member Ron Wyden (D-Ore.) interpret the Government Accountability Office report released Feb. 6.

"As demonstrated by this report, the provider outreach and responsiveness to stakeholder concerns from CMS have kept the agency on track to upgrade to the next level of healthcare coding," said Hatch said in a statement. "While additional testing will be needed to ensure its success, the transition to the new system will streamline the management of healthcare records and improve patient care. I will continue to keep a close eye on this issue but see no reason for any delay past the October deadline."

But, as many stakeholders will recall, it was all systems go for the ICD-10 launch at this time last year. Until the line, "The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10 code sets as the standard for code sets" was inserted into a bill aimed at determining how much physicians would be paid under Medicare. There was no discussion about ICD-10, and it appeared most senators were unaware of the provision that had been inserted in the bill.

463105901The Congressmen noted in the statement that "it is essential that we understand the state of preparedness at CMS. Following the most recent delay of ICD-10, we heard from a number of interested parties concerned about falling behind or halting progress."

But the GAO report released Friday gave ICD-10 proponents reasons for optimism.

"Today's report by the Government Accountability Office affirms widespread recognition across the health care industry that CMS is well-prepared to implement the U.S. transition to ICD-10 on October 1, 2015," the organization commented. "Coalition members are working together and with CMS to ensure a smooth and successful transition for all health care stakeholders. The U.S. is ready to move forward with ICD-10 with no further delays."

GAO examined the status of CMS activities to support healthcare providers and payers in the transition from ICD-9 to ICD-10 coding as well as CMS' own readiness to process claims from providers and payers.

From the findings, the senators concluded the ICD-10 conversion would meet the Oct. 1, 2015 deadline.

CMS reported to GAO that the agency has completed all ICD-10 related changes to its Medicare payment systems and that Medicaid agencies have reported they are ready for the change.

CMS documentation shows that testing to date has not identified any CMS-related issues and that additional testing will continue up to the date of implementation.

GAO said that CMS has taken action to help prepare stakeholders for the move to ICD-10, including in-person training sessions, teleconferences, educational materials, and monitoring the readiness of providers and payers. Many of the tools that CMS has developed are specifically geared towards small and rural providers.

GAO, which usually makes recommendations in its report, made none of its own in this one. The agency did, however, highlight several concerns from physician and hospital organizations. GAO tapped 28 stakeholders for their comments and recommendations.

1.Stakeholders expressed concerns that CMS testing activities have not been comprehensive.

2. All 28 stakeholders GAO contacted indicated that CMS' educational materials have been helpful to covered entities, however stakeholders were concerned about the extent to which those entities were aware of and using those materials.

Response: CMS officials said that the agency has scheduled end-to-end testing with 2,550 covered entities during three weeks in 2015 (in January, April, and July), and has promoted awareness of its educational materials by, for example, partnering with payers, providers, and others to direct users to available CMS and industry educational resources.

3. Stakeholders recommended that CMS expand its in-person training and develop additional specialty-specific materials.

Response: CMS officials said the agency has added in-person training in additional states with plans to also offer more video trainings, and planned to develop additional specialty-specific materials.

4. Stakeholders recommended that CMS do more to engage covered entities through non-electronic methods and to make its Medicare FFS contingency plans public.

Response: CMS officials indicated that the agency employs various methods to engage covered entities-including bi-weekly stakeholder collaboration meetings and print advertisements--and also conducted a direct mail pilot project to primary care practices in four states, and plans to expand the pilot. CMS officials also indicated the information in the agency's contingency plans that are relevant to providers is currently publicly available.