MGMA 'extremely concerned' that Medicare won't test ICD-10 with physician practices

Primary care physicians, who have already expressed uncertainty about meeting the Oct. 1, 2014, deadline for the implementation of the International Classification of Diseases Tenth Revision (ICD-10), now have an additional concern. The Centers for Medicare and Medicaid Services (CMS) will not conduct end-to-end external testing with physician practices.

In response, the Medical Group Management Association (MGMA) has sent a letter to Kathleen Sebelius, the secretary of Health and Human Services, that urges her to immediately reverse that policy and implement a plan.

The letter warns of “a catastrophic back-log of Medicare claims following the Oct. 1, 2014, compliance date” that could pile up if HHS doesn’t conduct external testing well in advance of the deadline.

It also warns of the consequences of a back-log.

“Failure to do so could result in significant cash flow disruption for physicians and their practices, and serious access-to-care issues for Medicare patients,” the letter states.

CMS says it will conduct rigorous internal testing of its system, but providers argue that without the necessary external testing, it will be impossible to discover any other issues before the rollout date.

But a larger concern, the MGMA notes, is that commercial health plans have often followed Medicare’s lead. MGMA says when HIPAA transitioned from Version 4010 to Version 5010, Medicare’s “National HIPAA 5010 Testing Week” spurred testing among other insurers. In this case, the MGMA is concerned that if CMS doesn’t externally test ICD-10, other commercial health plans won’t either.

Despite the absence of Medicare testing, it’s clear that physicians are already struggling with ICD-10 preparation.

In an MGMA survey last month, 55% of medical practices said they had not started the implementation process. In the same survey, 70% said they are “very concerned” about the loss of clinician productivity after implementation, which they rated higher as a greater concern than the cost of implementation and the changes to clinical documentation. 

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