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Quality & Governance News

ICD-10 Testing Scarce; Doubts Persist with Six Months Left

By Jennifer Bresnick

- Uncertainty, a lack of coordination, and a generally sluggish scramble for readiness mark the results of WEDI’s latest ICD-10 preparedness survey, released just six months before the October 1, 2015 deadline to implement the new codes.  With ICD-10 testing barely creeping past last year’s benchmarks and lingering doubts over whether or not the 2015 compliance date will truly stick, the industry continues to stumble over the same old obstacles that raise questions over readiness to enter a new era of detail and specificity for more accurate payment and healthcare data analytics.

ICD-10 deadline

The survey, conducted in February of 2015, is the latest of WEDI’s periodic efforts to gauge how much progress the industry has made in key implementation areas, including ICD-10 testing, vendor software development, product implementation, and feelings around the constantly shifting compliance deadline.

Providers are still feeling burned by last year’s surprise bait-and-switch delay, which was slipped into the 2014 SGR patch. Despite the fact that this year’s stalled legislation contains no mention of an additional pushback, some providers are keeping the hope alive that they will have more time to prepare for the new codes, or that the notion will be scrapped all together until ICD-11 is ready for use.

Organizations such as the Government Accountability Office (GAO) assert Medicare’s readiness to flip the switch, and a “successful” end-to-end ICD-10 testing week with CMS have raised proponents’ hopes that the industry is approaching a workable degree of readiness, yet a persistent unwillingness to accept that October 1, 2015 will be the finalized implementation date influenced more than half of respondents to this winter’s poll.

That uncertainty is having a deep impact on readiness activities across the board.  Only one third of ICD-10 software vendors have completed their product development.  Just three-fifths of products are available on the market or are being tested with customers.  Less than one fifth of physician provider organizations have completed their impact assessments, a critical step for developing a preparedness plan that shouldn’t just be set in stone by now – the activities on the list should be mostly complete.

ICD-10 testing remains one of the most complex aspects of the transition, and one that has slipped later and later into the preparation period.  While a previous survey in September of 2014 found that one third of provider organizations had started external testing, the number of testing providers actually decreased to one in four during the February 2015 poll.

Equally concerning is the fact that more than one quarter of providers do not expect to begin external testing until the second or third quarter of 2015, just weeks before the deadline.  A further third have no concrete plans to ensure their claims processing systems can correctly send and receive ICD-10 data to their payers, which may result in significant revenue cycle management issues and payment disruptions for services that must be coded in ICD-10.

“Based on the survey results, it appears the delay has had a negative impact on some readiness activities—especially external testing. Uncertainty over further delays was listed as a top obstacle across all industry segments,” said Jim Daley, WEDI past-chair and ICD-10 Workgroup co-chair. “While the delay provided more time for the transition to ICD-10, many organizations did not take full advantage of this additional time and many providers are falling further behind.”

Health plans are generally further along with their ICD-10 testing, with more than half of payers having started external testing procedures, but few expect to involve providers too heavily in their approach, which may be part of the reason why providers are feeling stuck.  Less than a quarter of payers will conduct ICD-10 testing with the majority of their business partners.  Three-fifths will pull a sample from their provider base, while 10 percent will only engage in external testing with clearinghouses.

Lawmakers have thus far seemed reluctant to consider an additional delay, despite the questionable preparedness of many healthcare providers, and a period of dual coding has been struck off the list of possibilities.  With just a few short months to go before October 1, WEDI urges “all industry segments [to] make a dedicated and aggressive effort to move forward with their implementation efforts in the next few months, [or] there will be significant disruption to industry claims processing on October 1, 2015.”

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