ICD-10: Last Year's Delay Has Negatively Affected Readiness

In early March, Marilyn Tavenner, outgoing administrator for the Centers for Medicare and Medicaid Services (CMS), announced that CMS is ready for ICD-10. According to a new survey, though, apparently the rest of the industry is not.

A February 2015 survey conducted by the Workgroup for Electronic Data Interchange (WEDI), the nation’s leading nonprofit authority on the use of health IT, revealed that the ICD-10 deadline delay had a negative impact on overall readiness, and continued uncertainty over further delays was listed as a top obstacle across all industry segments. In a letter sent to Sylvia Burwell, Secretary Department of Health and Human Services, Jim Daley, past-chair of WEDI said, “We assert that unless all industry segments make a dedicated and aggressive effort to move forward with their implementation efforts in the next few months, there will be significant disruption to industry claims processing on Oct 1, 2015.”

What’s the Hold Up?

While health plans and vendors saw modest gains or slight decreases in readiness—more than 50 percent of health plans have begun external testing, and of these, a few have completed testing, while about 60 percent of vendors indicated their products were available or they had started customer testing—the provider responses were most concerning.

Just over one-third of providers indicated they had completed an impact assessment—a decrease from the August 2014 survey when slightly over one-half had completed their assessment. Of those providers, three-fifths of the hospitals/health systems have completed assessments, while less than one-fifth of physician practices have done so.

Only one quarter of provider respondents had begun external testing and only a few others had completed this step—a decrease from the one-third of provider respondents that had begun external testing in the August 2014 survey. Another fourth of the respondents said they do not expect to begin external testing until the second or third quarter of 2015 and, disconcertedly, over one-third responded ‘unknown.’ Further analysis shows that while over one-half of hospitals/health systems had started external testing, just one-tenth of physician practices had.

What Should You Do?

With the October 1 deadline less than six months away, WEDI is urging payers, vendors, and providers to begin preparing for ICD-10 in earnest. Daley also suggested the entire industry prepare for the unexpected: “We encourage all organizations to establish plans for addressing any unforeseen events that may occur during the transition.”

If you don’t feel ready for ICD-10 yourself, especially if you are part of the two-thirds of providers who haven’t done an impact assessment or part of the one-third who doesn’t even know when you are planning to start testing, what should you do?

Review your own ICD-10 implementation plan. If you don’t have one, CMS’s Road to 10is a great place to start, especially for small practices.
If you haven’t already, arrange for an impact assessment as soon as possible.
Begin to talk with your payers and vendors, including billing companies, about their transition plans.
If you employ coders, prepare now for them to receive additional training on the expanded and increasingly specific code-set.
As part of your impact assessment, understand where your clinical documentation currently could use some improvement, and then have your coding staff attempt to code with ICD-10 from your current documentation to plan for further improvements needed after the transition.
Consider participating in testing opportunities with CMS and/or any commercial payers.

For a closer look at the WEDI survey, review the WEDI press release and letter sent to HHS.

And as always, if there is anything CIPROMS can do to help you with your transition to ICD-10, please don’t hesitate to contact us.