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AMA says ICD-10 needs back-up plan if testing reveals billing problems

CMS is conducting testing in March for claims submitted using the new code set


The American Medical Association (AMA) says it’s “deeply concerned” that a contingency plan has not been put in place if issues occur during ICD-10 testing this month.

“The slightest glitch in the ICD-10 rollout could potentially cause a billion dollar back-log of medical claims that jeopardizes physician practices and disrupts patients’ access to care,” Ardis Dee Hoven, MD, president of the AMA, said in a written statement. “The AMA is deeply concerned that Medicare does not have a back-up plan if last minute testing demonstrates anticipated problems with this massive coding transition. At the end of the day sticking hard and fast to the ICD-10 deadline without a back-up plan to address disruptions in medical claims processing will hurt doctors and their patients.”

The Centers for Medicare and Medicaid Services (CMS) is conducting front-end testing the first week in March for claims submitted using the ICD-10 code set.

During her keynote presentation at the 2014 Health Information and Management Systems Society (HIMSS) conference last week, CMS Administrator Marilyn Tavenner reiterated that there would be no more ICD-10 delays, which has sparked backlash from physician groups.

The AMA argues that vendors won’t be ready for the upgrade. The association released a study in February that showed the cost of implementing the new code set is between $213,364 and $824,735 for medium-sized practices.

“Many physicians are still waiting for their vendors to deliver updated software they need to use the ICD-10 codes,” said Hoven. “The later physicians receive this software, the harder it will become to test it out before the October 1 ICD-10 deadline. Testing is needed to discover problems and resolve them prior to the go live date.” 

In addition to this week’s testing, CMS will conduct end-to-end testing of more than 25,000 claims with a limited number of providers. 

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