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Fifty-one Percent “Somewhat” Ready for ICD-10: Healthcare Billing and Management Association Survey Reveals

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10/28/2014

ICD-10 MonitorWritten by 

The Healthcare Billing and Management Association (HBMA) resurveyed industry members this month in an effort to learn more about current progress toward the anticipated implementation of ICD-10 in October 2015 and ongoing impediments to readiness. Not unexpectedly, there was good news and bad news.

Perhaps most importantly, the results allow us to focus on the problem areas that could potentially threaten a smooth transition. Because HBMA members work directly with providers, practice management systems, clearinghouses, payers, and beneficiaries, our perspective offers depth and breadth on the issues.

In comparison to our previous survey, conducted in May of this year, there were some expected similarities. In both surveys more than 80 companies responded. Sizes of those companies ranged from fewer than 25 employees to more than 300 employees. Participants bill predominately for office-based physicians followed by multiple types of clients, including facilities, ASC, DME, ambulatory, etc. Seventy-nine percent of respondents bill in more than one state. Both proprietary and commercial practice management systems are relied upon by these respondents, and almost all submit claims through clearinghouses, as well as directly to payers. Coding is performed internally by coders who rely upon medical records, by clients, or is otherwise outsourced, computer-assisted, or accomplished using an electronic health record (EHR). Many companies have combinations or all of the above methodologies currently in use.

The good news is that more members are confident in their system’s capability to handle both ICD-9 and ICD-10 concurrently. The bad news is that 23 percent of respondents reported that system updates are not complete, and 37 percent of those that have not completed updates have no scheduled time for completion. As a result, internal testing is still lagging today.

As we all know, the industry is heavily reliant on clearinghouses. Open and transparent communication is critical to understanding current payer and claims status. Although 94 percent of our members use one or more clearinghouses, 39 percent have received no information that testing has been successful to date. Of the 61 percent who reported successful testing, 29 percent reported that was the case with syntax only. Only 27 percent have reported successful end-to-end testing. A full 49 percent are not familiar with the type of testing their clearinghouses are conducting. And overall, 83 percent anticipate that end-to-end testing will not be available until sometime in 2015. Given the importance of this step, these results are disappointing.

Costs also appear to remain a moving target, most likely due to the missing steps and known outcomes identified above. Thirty-nine percent of the companies to respond do not yet know what their final costs will be.   

The yearlong delay and seeming industry slowdown (or dead stop, depending on who is answering the questions) also have significantly changed our members’ confidence in readiness. In May, 89 percent believed the delay would allow them adequate time to be fully prepared for ICD-10 implementation. Now only 45 percent are confident they will be ready. Fifty-one percent are somewhat confident and 4 percent are not confident. Although one could argue that the 4 percent may encompass those who struggle to be ready no matter the date, the fact that only 45 percent are now confident they will not be ready for Oct. 1, 2015 is deeply concerning.  

So what did we see as the main impediments, then and now? The number one answer remains provider readiness. Number two is still end-to-end testing. The surprise is that 17 percent now rank uncertainty regarding whether ICD-10 will really happen as negatively impacting readiness.

So, what are our gold nuggets in this survey? I don’t think there is anything truly new or surprising. They are the same old problems we have rehashed ad nauseum without the hope for positive changes. The revenue cycle is a continuum, with every participant relying upon what happened before and what transpires after. Many key players have critical roles – the providers, coding, claim submission, payer systems, and vendors. No one participant can control all the steps to ensure success. Therefore, we must work together as a team. By now, we should be able to tell our provider clients exactly what they need to do for documentation improvement, and that should include payer policies. Policies vary widely, and what is medically appropriate for one is not always the same for another, but excellent documentation should be sufficient for all, and we need to know if it is not.

Testing by type, payer, and success (or lack thereof) should be shared with all key players. End-to-end testing is what will tell us we are truly ready. It is also likely the most important item on the list of absolutely necessary tasks. We need to know our revenue streams will remain steady. It’s hard to justify time, work, and money for an unknown end. We need the strongest assurances from the U.S. Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS), and our congressional representatives that the date is really the date this time. Even if you are adamantly opposed to ICD-10, a final answer is necessary and it should not be questionable at this late date.

Assuming that Oct. 1, 2015 is really it, there is a massive amount of work to accomplish. Let’s focus on the teamwork and steps required for success. If the same issues exist well into 2015, we shall surely fail.

About the Author

Holly is a member of the Healthcare Billing and Management Association (HBMA) and chairs the ICD-10 Committee.  The committee developed definitions for readiness and end-to-end testing for successful ICD-10 implementation. 

Contact the Author

Holly@pmiboise.com

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