Medicare Has Made Progress on ICD-10 Transition, Readiness, GAO Report Says

The Centers for Medicare & Medicaid Services has rolled out several policies and procedures to smooth the health-care industry’s transition to ICD-10, and a majority of stakeholders say the CMS efforts have been helpful, according to a report from the Government Accountability Office released Feb. 6.
“CMS has taken multiple steps to help prepare covered entities for the transition, including developing educational materials and conducting outreach, and the majority of the stakeholders we contacted reported that both of those activities have been helpful to preparing covered entities for the ICD-10 transition,” the report, “International Classification of Diseases: CMS’s Efforts to Prepare for the New Version of the Disease and Procedure Codes” (GAO-15-255), said.
The GAO said the CMS educational tools, which are all available on the CMS website, include:

  • information on why the ICD-10 transition is happening and how the ICD-10 codes differ from the existing ICD-9 codes;
  • checklists and timelines intended to help stakeholders make the transition in a timely and efficient manner;
  • videos and webinars; and
  • links to outside organizations that include further ICD-10 educational tools.
Agency ‘On Track.’
The report, which was prepared at the request of Sens. Orrin G. Hatch (R-Utah) and Ron Wyden (D-Ore.), chairman and ranking member, respectively, of the Senate Finance Committee, examined ICD-10 transition efforts within the CMS, as well as the concerns and reactions of 28 stakeholders between July 2014 and January.
In a Feb. 6 statement, Hatch said the GAO report provides evidence that “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.”
The Coalition for ICD-10, composed of industry stakeholders such as the Blue Cross and Blue Shield Association, America’s Health Insurance Plans and the Advanced Medical Technology Association, also released a Feb. 6 statement, and said it supported the GAO report’s findings. “Our members are engaging in significant efforts to identify and educate those in need of implementation assistance through payer-provider collaboratives, training and outreach initiatives, and programs to help coders continue to achieve complete and accurate coding,” the coalition said.
Upcoming Deadline
The deadline for ICD-10 (International Classification of Diseases, 10th Revision) implementation is Oct. 1.
The code set updates health-care diagnoses and procedure codes from the currently used 13,000 in ICD-9 to 68,000, and will be required for all Health Insurance Portability and Accountability Act covered entities. Originally scheduled to be implemented by Oct. 1, 2013, ICD-10 implementation has been twice delayed. The CMS in 2012 delayed implementation until Oct. 1, 2014, and the Protecting Access to Medicare Act of 2014 (H.R. 4302), signed by President Barack Obama in April 2014, delayed implementation again, until no later than Oct. 1, 2015. In August 2014, the CMS published a final rule designating Oct. 1, 2015, as the new implementation date.
The House Energy and Commerce Subcommittee on Health has scheduled a hearing for Feb. 11 to evaluate progress the health-care industry has made toward ICD-10 implementation.
Stakeholder Concerns
Although stakeholders expressed a variety of concerns over the coming ICD-10 transition and the CMS efforts to ease the transition, the GAO found that in most cases the CMS was able to take steps to alleviate stakeholder issues.
For example, 17 out of the 28 stakeholders interviewed by the GAO said they were concerned over the CMS’ lack of comprehensive ICD-10 testing and seven said they were concerned that the CMS wasn’t doing enough to communicate results of ICD-10 tests.
To alleviate the issue of comprehensive testing, the CMS scheduled three separate weeks of end-to-end ICD-10 testing involving 2,550 covered entities. The first week of testing was in late January, and the second week is scheduled for late April. The final testing week is scheduled for late July.
The CMS also told the GAO that it will be publicly releasing the results of the end-to-end testing, and the reports “will provide details about the types and numbers of testing participants, technical challenges that arise during testing, and CMS’s plans for fixing them.”
Lack of Awareness
Other stakeholder concerns identified in the GAO report included a lack of industry awareness of the CMS educational tools, a need to conduct more in-person ICD-10 training and a failure to address the administrative burdens associated with ICD-10.
The GAO said the CMS has partnered with a variety of outside organizations to promote awareness of ICD-10 educational tools, especially the Workgroup for Electronic Data Interchange (WEDI), and has been expanding the number of states in which it offers in-person ICD-10 training.
Although the CMS said originally it would conduct in-person ICD-10 training in 18 states, it has expanded the in-person sessions to 11 additional states as of January, the GAO said.
As for the administrative burdens associated with the ICD-10 transition, the CMS told the GAO that while it understands stakeholder concerns, it believes that ICD-10 “is foundational to advancing health care” and also has the potential to lower the administrative burden on providers.