ICD-10 in 2015: What physicians need to know about testing, costs and preparedness

The Centers for Medicare and Medicaid Services (CMS) is looking for volunteer providers to test the new International Classification of Diseases-10th revision (ICD-10) coding system from April 26 to May 1, 2015.

The test dates will serve as a practice run for a small group of providers to ensure they are able to submit claims with the ICD-10 codes to Medicare and that CMS’ software changes can support the new codes.

Physicians interested in participating the test run must fill out a form on CMS' Medicare Administrative Contractor's website by January 9. 

Read: ICD-10: Can physicians stave off or delay implementation?

Implementation of the ICD-10 coding system has been delayed repeatedly, with the current deadline set for October 1. To prepare, CMS has scheduled several test runs of the new system, and is collecting and analyzing data after each trial. During November’s trial, more than 500 participating providers submitted nearly 13,700 claims  using ICD-10 codes, and CMS accepted 76% of the total test claims.

According to CMS, the testing didn’t identify any problems with the Medicare Fee-for-Service (FFS) claims system, and some claims included intentional errors to ensure the claim would be rejected as a part of the negative testing process. The majority of other rejections were related to invalid National Provider Identifiers (NPIs), according to CMS.

Physicians who choose not to participate in the test runs but would still like to submit test claims can contact their Medicare Administrative Contractor for more information.

NEXT PAGE: ICD-10 costs under scrutiny

A new study is challenging the conventional belief that the costs of converting to the International Classification of Diseases-10th revision (ICD-10) code set will be prohibitive for small medical practices.

The study, published in the November issue of the Journal of the American Health Information Management Association (AHIMA) puts ICD-10 conversion costs for a three-physician practice in the range of $1,960 to $5,900. That contrasts with a widely quoted study prepared for the American Medical Association (AMA)-written in 2008 and updated earlier this year-concluding that small-practice conversion costs will range from $22,500 to $105,500.

Stanley Nachimson, principal of Nachimson Advisors, LLC, and author of the AMA study, stands by his estimates, saying “I didn’t see anything in the AHIMA article that would cause me to question the costs predicted in my study.”

The authors of the AHIMA study say their estimates are lower than those in the AMA study “as a result of readily available free and low-cost solutions offered by coding, education and software vendors.” Their findings are based on survey results, published results, and hospitals’ and physicians’ conversion experiences, they write.

In the area of ICD-10 training, they cite the availability of online documentation and coding training for three hours of clinician training at a cost of $50 to $300, and for staff from $350 to $700. They note that the ICD-10 Diagnoses Code Book can be downloaded for free or purchased from publishers for no more than $300.

In terms of upgrading software, the authors say many small practices are relying on their electronic health record (EHR) vendors, billing services, and clearinghouses to absorb the costs. “Physician office costs are not expected to change for basic software services and as a result software conversion costs are estimated to be zero for small practices,” they say. They also discount claims that small practices will have to undergo extensive end-to-end testing, because that responsibility lies with billing, EHR, and clearinghouse vendors, they say.

Nachimson notes that the AMA has long opposed ICD-10 conversion, while AHIMA has supported it. He says he “strongly disagrees” with many of the assumptions underlying the ICD-10 study. In the area of training, for example, just having printed materials is not enough. “I can give you a French dictionary, but that doesn’t make you fluent in French,” he says. “You need to learn the rules around using the words. It’s the same with having a code book. You need to learn the rules around using the codes.

“As a physician practice, you can chose to go through your ICD-10 implementation process any way you want,” he adds. “MY study measured the cost of an implementation meant to minimize the risks of moving from ICD-9 to ICD-10 and make sure physicians were prepared to use ICD-10 codes and get paid. If physicians choose not to take those steps their costs will be less, but the risks increase, I would say considerably.” 

NEXT PAGE: Many physicians remain unprepared for ICD-10

With 10 months to go until the transition, half of the physicians who answered Medical Economics’ exclusive 2014 physician survey said they are not ready for ICD-10. The reasons are many, but mostly come down to cost, productivity and technology hurdles, and lack of certainty in the transition.

While many physicians are not ready, the number who are prepared is up significantly from a large-scale survey in 2013 by the Medical Group Management Association in which fewer than 5% of practices reported having had made significant progress towards ICD-10 readiness.

Acknowledging the enormous outlay of resources required to transition to ICD-10, the Centers for Medicare and Medicaid Services (CMS), through congressional action, has twice pushed back the compliance date, first from October 2013 to 2014, and then to 2015.

But physicians, health plans and electronic health record (EHR) vendors should not assume another delay. Stanley Nachimson, principal of Nachimson Advisors and an expert on ICD-10,  estimates there is a 75% chance that the ICD-10 transition will actually take place in October 2015. Most EHR vendors have already upgraded their software to reflect the new codes.

“The health plans and vendors are moving forward and getting out ahead of the providers,” he says. “It’s time for the providers to catch up. Doctors need to be somewhat assertive and start taking steps to move forward on ICD-10. I’m not sure I’d want to take a chance of my revenue getting interrupted.”