GAO Gives CMS ICD-10 Readiness Thumbs Up

Efforts by the Centers for Medicare and Medicaid Services to prepare providers, clearinghouses, and health plans for the October 1 ICD-10 deadline are on track, and CMS is ready to process claims using the new codes.

That is the conclusion of a just-released Government Accountability Office report on the readiness of CMS for the ICD-10 switchover.

“The transition to ICD-10 codes requires both CMS and covered entities to develop, test, and implement information technology systems that can process the new codes,” states the GAO report. “In addition, these covered entities need to educate and train staff in using these new codes, and may need to modify internal business processes.”

According to GAO, CMS has developed various educational materials, conducted outreach, and monitored the readiness of covered entities and the vendors that support them for the ICD-10 transition. For example, the agency held in-person training for small physician practices in some states and monitored readiness through stakeholder collaboration meetings, focus group testing, and reviews of industry surveys, finds the report.  

GAO also reported that CMS modified its Medicare systems and policies. For example, the agency completed all ICD-10-related changes to its Medicare fee-for-service (FFS) claims processing systems. Auditors also found that the agency provided technical assistance to Medicaid agencies and monitored their ICD-10 readiness. As a result, all Medicaid agencies reported that they would be able to perform all of the activities that CMS has identified as critical by the October 1 implementation deadline.

Nonetheless, while CMS’s Medicare FFS claims processing systems have been updated to reflect ICD-10 codes, GAO states that “it is not yet known whether any changes might be necessary based upon the agency’s ongoing external testing activities.” Auditors also conclude that although CMS has worked with states to help ensure that their Medicaid systems are ready for the ICD-10 transition, “in many states, work remains to complete testing by the transition deadline.”

At the same time, GAO reports that stakeholder organizations identified several areas of concern about the ICD-10 transition and made several recommendations, which CMS has taken steps to address. For example, stakeholders expressed concerns that CMS's testing activities have not been comprehensive. To address this concern, CMS officials said that the agency has scheduled end-to-end testing with 2,550 covered entities during three weeks in 2015 (in January, April, and July).

In response to the GAO report, Senate Finance Committee Chairman Orrin Hatch (R-Utah) and Ranking Member Ron Wyden (D-Ore.) issued a statement saying they have “confidence” that CMS is “adequately preparing to implement” ICD-10 by the October 1 deadline. “As demonstrated by this report, the provider outreach and responsiveness to stakeholder concerns from CMS have kept the agency on track to upgrade to the next level of healthcare coding,” said Hatch. Wyden added that CMS has “taken unprecedented actions to help providers prepare for this change.” 

Similarly, the Coalition for ICD-10 in a statement said that the GAO report “affirms widespread recognition across the healthcare industry that CMS is well-prepared to implement the U.S. transition to ICD-10 on October 1, 2015, and that the agency has undertaken extensive efforts to help the health care industry prepare,” adding that “the U.S. is ready to move forward with ICD-10 with no further delays.”