ICD-10 Implementation

The Medical Group Management Association (MGMA) believes the transition to ICD-10 was extremely challenging for medical groups.

The ICD-10 deadline of October 1, 2015 has approached and MGMA continues to advocate on behalf of our members and provide tools and resources to help make ICD-10 coding more cost effective and less disruptive to their organizations. 

Take a look at the comprehensive list of ICD-10 training, resources, and guides below to help your healthcare organization with ICD-10.

Expanding Item - View MoreWhat is ICD-10?

As of Oct. 1, 2015, physician practices are required to adopt the International Classification of Diseases, 10th Revision (ICD-10) code set for diagnosis.

For physician practices, the change to the new ICD-10 code set has proven to be one of the most complex and expensive undertakings in many years.

There are numerous steps medical practice professionals must taken in order to ensure that their organization was prepared to submit claims using ICD-10 codes. External partners must also have been ready in advance of the compliance date and many of these ran significantly behind schedule.

  • Training clinical and administrative
  • Practice management
  • EHR software vendors
  • Clearinghouse and health plans

In a recent MGMA LEARN survey, less than one in ten MGMA members reported being ready for the ICD-10 transition. Medical practices were expected to incur significant ICD-10 implementation expenses, decreased coder and clinician productivity, and ran the risk of cash flow disruption if a large numbers of claims were pended or rejected after the Oct.1 deadline.

MGMA has repeatedly expressed concerns about industry preparedness for ICD-10 and has been a strong advocate for complete end-to-end testing to ensure a smooth transition and avoid cash-flow disruptions for medical practices.

Who is affected by the transition to HIPAA Version 5010 and ICD-10?

HIPAA-covered entities affected by the transition to Version 5010 and ICD-10 include:

  • Providers, such as physicians, alternate-site providers, rehabilitation clinics and hospitals
  • Health plans
  • Health care clearinghouses
  • Business associates that use the affected transactions, such as billing/service agents and vendors

*Note that practice management system vendors are a critical component in this process but are not HIPAA-covered entities.


Expanding Item - View MoreWhere to start?

Before the ICD-10 mandate takes effect, your practice should: 

  • Identify and budget for required systems changes
    • Software changes
    • Increased system storage capacity
  • Know if the necessary upgrades are covered by current vendor contracts
  • Indentify for what upgrade costs your practice will be responsible
  • Resource allocation to manage all requirements
    • 5010/ICD-10
    • Administrative Simplification
    • Meaningful Use
  • Determine how best to take full advantage of these standards
    • Claim (837) / Eligibility (270/271) /Claim status (278)
    • Remittance (835) / Authorization and referral (277)
  • Determine the preparedness of your vendors, payers, providers 
    • If 4010, NPI are any indication… 


Expanding Item - View MoreQuestions for your practice management system (PMS) software vendor

  • Are you aware of these (and other) new government regulations?
  • What is your schedule for 5010 and ICD-10 software upgrades/training?
  • Will you be upgrading MY version of the software?
  • If yes, what will be the cost for this upgrade?
  • If not, what will be the cost for the version of the PMS software that will accommodate 5010/ICD-10?
  • Will you be combining the upgrades for both mandates?
  • Will you be offering any 5010 and ICD-10 training?
  • (If a current or potential electronic health record (EHR) user) What modifications to my EHR must be made in order to accommodate 5010 and ICD-10?
  • What type of EHR/PMS interface do you offer?
  • Will I require additional hardware to support the software modifications to my PMS software? If yes, what will be required and what will these upgrades cost?


Expanding Item - View MorePMS vendor checklist

  • Vendors identified
  • Profiled with contact information
  • Vendor contracts assessed
  • Release schedule identified
  • Staff training offered 
  • Consideration of trading partners
  • Testing (theirs and yours)
  • Implementation timeframes
  • Deployment plan
  • Electronic patient statements vs explanations of benefits 
  • All additional "go-live" factors 


Expanding Item - View MoreQuestions for your health plans

  • When do you anticipate being ready to test each of the 5010 transactions?
    • 837 (Professional Claim)
    • 270/271 (Eligibility)
    • 276/277 (Claim Status)
    • 835 (Remittance)
    • 278 (Referral Certification and Authorization)
  • Will you be utilizing the CMS ICD-10 GEMs/crosswalks?
  • When will you let us know about changes to coverage and payment due to ICD-10?
  • Will you be offering any training or guidance regarding the migration to 5010/ICD-10?



MGMA ICD-10 Resources:

ICD-10 News:

For all the latest, visit MGMA's Washington Connection archive.

MGMA ICD-10 and 5010 Implementation Advocacy:

The latest updates on MGMA's advocacy on behalf of our members on ICD-10 coding.

See all of MGMA's advocacy efforts on ICD-10 related issues, and healthcare policies in our Advocacy Archive.

CMS ICD-10 and 5010 Resources:


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