2 Key ICD-10 Points-Counterpoints to Consider Within 21 Days

September 09, 2015 - ICD-10 implementation is here in only 21 days – merely 3 weeks’ time. As RevCycleIntelligence.com continues to report on the greater implications of ICD-10 implementation amongst the greater healthcare industry, the ability to agree to disagree has taken firm precedence, especially over the course of the last several months. Here are 2 significant questions to consider today that address essential ICD-10 points and counterpoints.

Was Medicare Fee-for-Service testing really successful?

The Centers for Medicare & Medicaid Services (CMS) announced an 87 percent acceptance rate during its third week of ICD-10 Medicare Fee-for-Service End-to-End Testing conducted last July. “Testing demonstrated that CMS systems are ready to accept ICD-10 claims,” said CMS. Rejections stemmed solely from errors not related to ICD-10, such as provider submission errors, incorrect NPI Health Insurance Claim Numbers or invalid service dates “that would not occur” during actual testing, CMS added.

Considering the flipside opinion of CMS’s claim, some argue such victorious testing results are similar to only reporting the grade point averages of top-performing valedictorians and surreptitiously leaving out the rest of the class when it comes to quantifying triumph. The belief holds steadfast that CMS’s testing was perhaps not as “successful” as presented with high-performing sample sizes not truly reflective of the actual testing population. As HealthITAnalytics confirmed, it is feasible only those ready for ICD-10 end-to-end testing were the ones volunteering and results are merely honed in on those at the top of the class.

Others confirm skepticism of CMS’s “successful” ICD-10 testing announcement. In a letter addressed to Andy Slavitt, Acting Administrator at CMS, four state medical societies explained how earlier end-to-end testing results generated “little confidence that the nation’s physicians, electronic health records, claims clearinghouses, commercial insurance companies, and government agencies will be ready when we ‘throw the switch’ to ICD-10.” The medical societies additionally confirmed ICD-10 implementation has no tangible advantage and is simply not worth the time, the energy, or the cost, especially as massive productivity free falls are anticipated shortly.

How confident is the healthcare industry about preparation levels?

The presentation of ICD-10 implementation in direct relation to confidence levels is a key motif echoed time and time again within ICD-10 announcements. Numbers have been floating around throughout recent months confirming a varying degree of ICD-10 confidence levels. According to such numbers, the healthcare industry is collectively more confident than before in its ICD-10 readiness and preparation efforts come October.

According to April reports:

• 11 percent of healthcare organizations are “highly confident” their staff will be well trained come October.
• 35 percent are reportedly “not at all confident” in staff readiness levels

August reports are as follows:

• 65 percent of physicians have “little to no confidence”
• Over half of solo practitioners are “not at all confident”
• 90 percent of healthcare providers lack ICD-10 confidence

There has, however, been much greater optimism reported come September:

• 85 percent of healthcare organizations are “very confident” 

In brief, healthcare organizations’ confidence in ICD-10 success surged to 85 percent from 11 percent in a matter of months. Assuming there is a concrete validity to the reported numbers, what might the cause of a sudden surge in ICD-10 confidence levels be? Such is a vital question to consider, especially with the prevalence of rather dejected statements from leading healthcare experts – namely the President of the American Medical Association, Robert M. Wah, MD. According to Wah, Medicare will very likely reject 1 in 5 claims in 21 days – there are indeed millions of claims to be processed in total – and, therefore, manifest an “intolerable and unnecessary disruption to physician practices.” 

Said Wah in a personal interview with RevCycleIntelligence.com, “As an industry, we need to ensure that the transition to ICD-10 is smooth and there are adequate contingency plans in place to prevent large-scale interruptions in claims processing and reimbursement.” Such ideas can perhaps be interpreted as starkly contrasting with the healthcare industry's sudden "confidence" in ICD-10 claims reimbursement success.

Does this mean the healthcare industry is confidently staring financial failure in the face? Considering one angle in light of statements such as the aforementioned from Wah, perhaps the numbers reporting on "confidence" levels are merely skewed or surveys are simply flawed. Or maybe the numbers are accurate and the healthcare industry is merely battening down the claims management hatches a tad better than before. Nonetheless, perchance even a false aura of confidence is better than fretting. Or perhaps ICD-10 confidence is only admirable when it is not misplaced and the notable gap between achievements and confidence levels is merely alarming to say the least, as EHRIntelligence.com stated. 

For now, at least the concrete notion that only 21 days remain until ICD-10 implementation begins on October 1 is one fact that is far from ambiguously theoretical.