Despite slow progress, 5010 and ICD-10 deadlines still challenge providers
WASHINGTON – A lack of significant progress on implementing both HIPAA 5010 and ICD-10 by providers is unlikely to change the hard line taken by the Centers for Medicare & Medicaid Services, despite a late year challenge by the American Medical Association.
Nonetheless, CMS is not completely blind to the lagging implementation of HIPAA 5010. In mid-November, roughly 45 days before the January 1, 2012 compliance date, CMS’ Office of E-Health Standards and Services (OESS) announced it would not initiate enforcement action against non-compliant companies until after March 31, 2012. Calling the extension a “discretionary” enforcement period, CMS still insisted that covered entities be compliant by the January 1 deadline, or at least be making good faith progress toward compliance.
“Feedback indicates that the number of submitters, the volume of transactions, and other testing data used as indicators of the industry’s readiness to comply with the new standards have been low across some industry sectors,” noted the November 17 announcement. “OESS has also received reports that many covered entities are still awaiting software upgrades.”
One significant problem that remains for 5010 implementation and readiness has been the lack of specific guidelines from CMS and OESS on an exact definition of readiness for the different stakeholders.
“We began to notice that when someone said, ‘Oh, we’re ready,’ their meaning of ‘ready’ didn’t match the hearer’s definition of ‘ready,” said Bob Burleigh, co-chair of the Healthcare Billing & Management Association 5010/ICD-10 committee. “If the vendor is ready but there’s no insurer with whom they can exchange information because none of the insurers are ready, then the word ‘ready’ doesn’t have much meaning.”
Meanwhile, on the ICD-10 front, the story is much the same, though the deadline for ICD-10 compliance is still more than 20 months away. Further complicating matters was a late year vote by the American Medical Association (AMA) House of Delegates announcing that the organization would “work vigorously to stop implementation of ICD-10.”
"The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patients' care," said Peter W. Carmel, MD, AMA president, in announcing the association’s opposition. In it’s statement the AMA contends that implementation of ICD-10 would cost a three-doctor practice $83,290 to implement ICD-10, and a 10-physician practice would spend $285,195 to implementation the new coding standard.
Many saw the new stance by AMA as both too late and not well informed.
The American Health Information Management Association responded to the AMA’s new opposition by noting that a delay in ICD-10 implementation would only add to the costs of getting the new coding system up and running. Further, it noted, there would be a domino effect that would also delay or significantly compromise the adoption of EHRs and negatively affect the implementation of the state health insurance exchanges by 2014.
“There are countless benefits that will come from the use of a 21st century classification system,” said AHIMA CEO Lynne Thomas Gordon, in a statement opposing the AMA action. “We need to move our disease classification system toward international standards and also align it with the Meaningful Use incentive program as well as value-based reimbursement.”
One good sign for ICD-10 has been the number of significant industry vendors and service providers that have stepped up to the plate in the past year launching and improving their ICD-10 solutions for the provider community.
CMS has been very active in rolling out ICD-10 resources for providers to help aid the transition and in late summer announced it would contract to 3M Information Services to license its ICD-10 code translation tool as it looks to translate systems, applications and supports currently in ICD-9 to ICD-10 coding.