GAO Report Offers Positive Outlook for ICD-10 Transition

| February 10, 2015 |

CMS and stakeholders appear to be on track to meet deadlines necessary to begin processing ICD-10 code sets by the Oct. 1 deadline, according to a new Government Accountability Office report, Health Data Management reports (Slabodkin, Health Data Management, 2/9).

U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures by Oct. 1.

Report Details

The report, which was requested by Sens. Orrin Hatch (R-Utah) and Ron Wyden (D-Ore.), provides an overview of CMS’ activities related the ICD-10 transition (Gold et al., “Morning eHealth,” Politico, 2/9).

For the report, GAO interviewed 28 stakeholders to determine how CMS had responded to their concerns regarding the shift to ICD-10.

Some of the stakeholders interviewed included representatives from:

  • American Health Information Management Association;
  • American Medical Association;
  • Healthcare Billing and Management Association;
  • Medical Group Management Association;
  • Workgroup for Electronic Data Interchange; and
  • Other various medical specialty societies.

However, the report does not contain the results of last week’s external, end-to-end testing of Medicare claims-processing systems (Conn, Modern Healthcare, 2/6).

The report also does not include the preparation of private payers and provider organizations (Bresnick, EHR Intelligence, 2/9).

Report Findings

The report authors listed what the agency has accomplished in terms of preparing for the transition and also laid out areas of concern about the agency’s readiness for the switch.

In terms of achievements, GAO found that CMS has:

  • Completed all ICD-10 changes necessary for its Medicare fee-for-service claims processing systems;
  • Engaged in outreach;
  • Tracked stakeholders’ readiness;
  • Monitored state agencies’ preparedness for the transition;
  • Offered technical support to state Medicaid agencies; and
  • Produced educational materials about the transition (Modern Healthcare, 2/9).

However, GAO noted that “it is not yet known whether any changes might be necessary based upon the agency’s ongoing external testing activities.”

GAO also stated that while CMS has worked with state Medicaid systems to prepare for the ICD-10 transition, “in many states, work remains to complete testing by the transition deadline” (Health Data Management, 2/9).

Despite that, all Medicaid agencies said they would be able to perform “all of the activities that CMS has identified as critical” by the Oct. 1 deadline, according to the report (Modern Healthcare, 2/9).


In a joint statement, Hatch and Wyden said they have “confidence” that the agency is “adequately preparing to implement” ICD-10 by the deadline.

Similarly, the Coalition for ICD-10 in a statement said the report “affirms widespread recognition across the health care industry that CMS is well-prepared” for the implementation and that “the U.S. is ready to move forward with ICD-10 with no further delays” (Health Data Management, 2/9).

Meanwhile, Stanley Nachimson, a health IT consultant and ICD-10 specialist, said he “continue[s] to be a little concerned that the industry relies too much on CMS to get all this educational activity out there.” He noted that most plans “will be ready in some way, shape or form” but added that he expects about 15% to 25% of providers will not be prepared (Modern Healthcare, 2/9).

Michael Lee, director of clinical informatics for Atrius Health, also raised concerns over CMS’ testing schedule, noting, “If there are testing failures in March that are significant, you only have until October to fix them,” which is “a pretty short amount of time.” He added, “It’s been a recurring theme with our communications with CMS around both meaningful use and ICD-10 that the expectations for technology changes have underestimated the technical complexity and the true safe delivery of software” (EHR Intelligence, 2/9).

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