The costs, training and impact of HIPAA's new electronic claim standard (5010) have been underestimated by the Department of Health and Human Services (HHS), and must be readdressed prior to the ICD-10-CM code set conversion, according to the American Medical Association (AMA).
"Physicians are deeply concerned that a hasty transition to a new, complex coding system will result in chaos for all involved, especially if the transition is done in tandem with the implementation of 5010,” said Joseph M. Heyman, MD, board chair of AMA.
In a letter, dated Oct. 21, the AMA and its partners in organized medicine outlined their concerns to HHS Secretary Michael Leavitt, calling for a revised implementation timeline to ensure a smooth transition.
According to the ICD-10 proposed rule, the new code sets would “likely represent the most complex of all the HIPAA code sets.” Many regard the conversion as a more complex undertaking than the adoptions of the first version of HIPAA standards (4010) and of the National Provider Identifier (NPI).
The AMA said that many physicians and other healthcare professionals are still struggling with the transition to the NPI, and have not received Medicare reimbursements since May 23, which has “significantly impacted cash flow, claims processing and the overall management of their practices.” The AMA contends that following an effective NPI implementation process and timeline would have reduced disruptions for physicians, other healthcare professionals and their patients.
The AMA and its partners said that in an effort not to repeat the mistakes made with the NPI implementation, and try to alleviate the cost and disruption to practices for converting to ICD-10, they have proposed that:
- HHS provide at least 36 months to adopt and implement 5010 from the date of publication of the 5010 final rule so as to accommodate all levels of testing;
- The National Committee on Vital and Health Statistics be charged with monitoring industry readiness through WEDI surveys, Medicare data and the use of other sources in order to ascertain whether healthcare providers (especially small physician offices), clearinghouses and payors are able to send and receive transactions using the 5010 standard and report findings and recommendations, including any adjustments to compliance deadlines, to HHS; and
- HHS require adoption of ICD-10 no sooner than 60 months following the publication of the 5010 final rule and after 5010 industry readiness levels have reached at least 95 percent.
“HHS underestimated the challenges associated with the NPI transition. We want to avoid repeating mistakes that come with pursuing an overly aggressive compliance deadline,” the association wrote.