5010, ICD-10 Deadlines Likely to Survive Health IT 'Perfect Storm'

June 10, 2011

If you are leaning more towards procrastination than preparation when it comes to readying for CMS' compliance deadlines for 5010 and ICD-10, you may want to start taking action. But when it comes to Stage 2 of proving meaningful use for your EHR, you might be in luck.

If you are leaning more towards procrastination than preparation when it comes to readying for CMS' compliance deadlines for 5010 and ICD-10, you may want to start taking action. But when it comes to Stage 2 of proving meaningful use for your EHR, you might be in luck.

Joe Miller, director of e-business for health plan administrator AmeriHealthMercy, recently gave such a forecast as he discussed the health IT "perfect storm" currently hitting practices in an online presentation for HIMSS. Miller said he and others have been talking about the looming storm of government IT-based initiatives impacting physician practices for years and it is now past the point of warning.

"The storm is not brewing anymore; it's hit," Miller said.

Perhaps the most noticeable signs of the storm, Miller noted, are the 5010 electronic claims transaction standards taking effect Jan. 1, 2012, and the conversion to ICD-10 codes, requiring compliance by Oct. 1, 2013. Citing research by groups including the AMA and MGMA, data indicates that many practices are far behind in their preparations, from failure to upgrade computer systems to not beginning the first testing phase of 5010 with only six months until implementation.

But will failure to act, both at a practice level and also on the part of vendors, prompt CMS to be lenient on shutting off claims payments as of Jan. 2? Don't count on it, Miller said.

"CMS has indicated no plans to change the date … so it would not be wise to assume while many are behind that the date will change," he said. "The date will stay. So if you can get 5010 out of the way as soon as possible, I'd advise it."

And regarding the coding change that accompanies those claims, Miller said the time between now and the on switch for ICD-10 is "sizable," with many practices still in the assessment phase. But again, don't count on a glitch with 5010 to bump the mid-2013 compliance date for ICD-10, Miller says, because it could not happen.

Regardless, Miller says today, practices use a "fairly small" number of ICD-9 codes, meaning they'll likely use a fairly small number of codes from its successor, ICD-10. Therefore, practices need to look at their own situations versus the entire coding landscape.

Now practices might catch a break when it comes to Stage 2 of proving meaningful use of their EHRs to the federal government, set currently to start in 2013. Miller notes that with Stage 1 underway, there are indications - from a CHIME survey to other similar studies - suggesting that practices will indeed meet Stage 1, but it may not be for another year or two.

So with a slower implementation of meaningful use of EHRs, plus 5010, and ICD-10 - and all the overlap in the initiatives - Miller notes there is a chance that Stage 2 could be delayed until 2014, as recently recommended by the Health IT Policy Committee.

“If [CMS] looked at it and could do it again …there probably would have been more coordination, better timing between initiatives,” Miller said.

But the bottom line is as of today, your practice has to deal with 5010, ICD-10, Stage 1 and Stage 2 of meaningful use for your EHR, the impact of the Affordable Care Act, possible compliance regarding health information exchanges, and other possible rules down the line. And don’t forget you still have to see patients, keep your staff happy, and keep your overhead low.

Smaller practices, Miller said have “one of the greatest challenges” when it comes to all the initiatives and compliance deadlines, but never fear, it can be done.

“For small practices, I think the real key is to try and keep things as simple as possible and find the best possible partnership with a vendor,” he said. “Small practices typically don't have the resources to customize/fit systems into old work flow…[they] need to find a product that fits best and move on with it." He also reminded smaller practices to utilize their regional extension centers (RECs) for help.

For all practices, Miller again repeated the “perfect storm” analogy, but said the clouds in the sky do have silver linings.

“I think what the 'perfect storm' has provided us with is the potential for the perfect wave. There are enormous changes in the HIT industry …and the successful organizations will be the organizations that find the perfect wave and ride it,” he said. “They'll ride those key initiatives and come into shore safer and faster than their competitors.”