Health Information Management

News: SGR passes without ICD-10 amendments; Survey says repeated delays hampered ICD-10 preparation; CMS notes another successful acknowledgment testing week

CDI Strategies, April 16, 2015

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At 11:30 p.m., Tuesday, April 14, Congress passed the Medicare and CHIP Reauthorization Act (MACRA), which effectively eliminated the more than 17-year battle over cuts to physician reimbursement associated with the Sustainable Growth Rate (SGR).

The new law puts in place a merit-based incentive payment system (MIPS) that awards bonuses or imposes penalties based on physicians’ composite performance scores and would take effect on January 1, 2019.

During the 2014 Congressional battle over the SGR, a last minute amendment delayed ICD-10-CM/PCS implementation from its October 1, 2014 date. CMS then pinned implementation a year out to its current October 1, 2015 deadline. No delay language was included in this year’s SGR fix.

ICD-10 implementation delays had a negative effect on the healthcare industry’s preparations for the code set change, according to the Workgroup for Electronic Data Interchange (WEDI) February 2015 readiness survey.

A total of 1,174 health plans, clearinghouses, vendors, and providers answered the February 2015 survey—twice as many as participated in the August 2014 survey—with providers making up the largest group (796) of participants. WEDI has conducted ICD-10 readiness surveys since 2009.

WEDI asked providers to list the top three obstacles in ICD-10 planning and implementation to which respondents listed continuing uncertainty about the final implementation date at the top followed by staffing and competing priorities as additional difficulties.

All respondents have started vendor development related to ICD-10. Approximately 80% of health plans completed impact assessments, and more than half of health plans responding started external testing, according to the survey results.

Meanwhile, CMS continues to mark its ICD-10 advancements announcing another successful completion of its March 2015 ICD-10 acknowledgement testing week. CMS accepted 91.8% of the 9,000 test claims submitted by 775 participants. The agency says healthcare professionals are making tremendous progress toward the implementation of ICD-10 on October 1, 2015.

Acknowledgement testing gives providers the opportunity to practice submitting claims with ICD-10 codes to the Medicare Fee-For-Service (FFS) claims systems. They receive electronic acknowledgements, confirming that their claims were accepted.

The majority of denied claims were rejected due to unrelated issues, CMS says, including invalid National Provider Identifiers (NPI), invalid Healthcare Common Procedure Coding System (HCPCS) codes, and invalid postal zip codes. CMS rejected a few, 8.2% of claims, because testers used future dates, which should not be an issue after implementation.

The claim acceptance rates were higher than previous testing weeks in November 2014 and March 2014

The next acknowledgement testing week is slated for June 1, 2015 through June 5, 2015. Providers are also welcome to submit acknowledgement test claims anytime up to the implementation date.

Editor’s Note: Portions of this article were compiled from and The HIPAA-HIM Insider


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