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7/23/2013
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MGMA Protests Decision Not To Test ICD-10 With Medicare

Government's decision against end-to-end testing would be "catastrophic" for practices, Medical Group Management Association says in letter to Health and Human Services' Sebelius.

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The Medical Group Management Association (MGMA), representing 13,200 organizations that include 280,000 physicians, has sent a letter to Kathleen Sebelius, the Secretary of Health and Human Services, protesting the decision of Medicare not to do end-to-end testing of ICD-10 claims submissions from healthcare providers to Medicare contractors.

The American Hospital Association also has concerns about this policy, although the AHA doesn't believe it has been finalized yet, association officials told InformationWeek Healthcare.

MGMA's letter said that it is "extremely concerned with the Medicare announcement that it will not be conducting ICD-10 end-to-end testing with external trading partners, including physician practices … This action would increase the potential of a catastrophic backlog of Medicare claims following the Oct. 1, 2014 compliance date. Failure to [test] could result in significant cash flow disruption for physicians and their practices, and serious access to care issues for Medicare patients."

[ Struggling with an electronic healthcare record system? Read Why Some Doctors Don't Lean On EHR. ]

Noting the extremely complicated nature of the transition to the ICD-10 diagnostic code set, MGMA said, "End-to-end testing between trading partners is absolutely critical to measure operational predictability and readiness, and also to identify any roadblocks well in advance of the compliance date."

Moreover, the association said, commercial health plans tend to take their lead from Medicare. If Medicare decides that end-to-end testing is unnecessary, many of these private insurers will also decline to do testing. "Again, this could result in practitioners not being paid for their services and disruption to healthcare service delivery," the letter said.

MGMA cited several inconsistencies between this decision and other policies of the Centers for Medicare and Medicaid Services (CMS):

-- Medicare conducted end-to-end testing with providers for the industry-wide transition from the HIPAA 4010 transaction set to the 5010 set well in advance of the compliance date.

-- Last fall, CMS contracted with National Government Services (NGS), a Medicare contractor, to develop a checklist for testing of ICD-10 and other standards required by the government. NGS recommended that providers test ICD-10 with Medicare.

-- CMS is requiring all state Medicaid agencies to test with their external trading partners, including providers.

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jaysimmons
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jaysimmons,
User Rank: Apprentice
8/12/2013 | 10:59:06 PM
re: MGMA Protests Decision Not To Test ICD-10 With Medicare
I agree with MGMA, such huge changes such as the change from ICD-9 to ICD-10 cannot be accomplished without sufficient testing from all entities involved. Medicare needs to sufficiently test ICD-10 end to end so that the bugs and kinks can be worked out before the implementation of ICD-10. With any implementation of a new product, testing needs to be done so that there are fewer complications when a product is live. Planning ahead is crucial for a smooth transition.

Jay Simmons
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