Many Physicians Still Unprepared for ICD-10

Ken Terry

June 22, 2015

With less than 4 months to go before the October 1, 2015, transition to the International Classification of Diseases (ICD)-10 diagnostic coding, many hospitals and physician practices have taken many of the necessary steps toward implementation, but still lag behind in a crucial part of the process — testing.

According to an eHealth Initiative (eHI) survey conducted in conjunction with the American Health Information Management Association (AHIMA), just 17% of physician practices have conducted test transactions with payers and clearinghouses, and only 5% have completed internal testing.

Higher percentages of practices have trained staff on ICD-10 (41%) and performed technical system upgrades/updates to support ICD-10 (36%), eHI reported.

Underlining the anxiety of physicians about the impending shift to the new coding system, the American Academy of Family Physicians (AAFP) last Wednesday urged the Centers for Medicare & Medicaid Services (CMS) to "specify that for three years, [Recovery Audit Contractors] will not audit and seek recoupment for claims whose sole error is due to the ICD-10 transition." In its letter to Health and Human Services Secretary Sylvia Mathews Burwell, the AAFP called on CMS "to only target Medicare claims that are legitimate fraud."

Of the 271 respondents to the eHI/AHIMA survey, 69% represented hospitals or healthcare systems, and only 18% came from physician practices. So the results provide a very partial view of how physicians are responding to the ICD-10 transition. Still, these results indicate that both physicians and hospitals still have a long way to go in their preparations.

In general, hospitals are farther ahead than physicians, and large organizations are making faster progress than small ones. For example, 41% of practices have trained their staff on using ICD-10 vs 85% of hospitals, and 62% of small organizations have done so vs 79% of large organizations.

Overall, 72% of respondents said their organizations had trained their staff on ICD-10, 73% had formed a team to assess their readiness and prepare for implementation, 66% had performed required system upgrades, 64% had performed internal analyses to detect readiness gaps, 55% had budgeted for time and costs associated with the transition, 50% had conducted test transactions with payers and clearinghouses, 34% had conducted internal testing, and 17% had completed external testing. Only 19% of the respondents said they had no plans to conduct end-to-end ICD-10 testing.

Based on the initial test results, the healthcare executives said that their best prepared trading partners were claims clearinghouses (52%), Medicare (52%), and technology vendors (63%). The least prepared partners were Medicaid (24%), other providers (26%), and private payers (22%).

Thirty-eight percent of respondents predicted that the move to ICD-10 would decrease their revenue. Six percent said it would increase revenue, and 21% said revenue would not be affected. The remainder (34%) said their organization hadn't conducted a revenue impact assessment.

The top reasons given for the expectation of decreased revenue were a higher number of denied claims or decreased reimbursement (78%) and reduced coding productivity or accuracy (80%).

Making the Best of It

To mitigate productivity losses due to ICD-10, respondents said their organizations would:

  • Offer additional training and practice (53%)

  • Contract with outsourced coding companies (51%)

  • Hire additional coders (41%)

  • Purchase computer-assisted coding technology (35%)

  • Autocode from electronic health record templates (12%)

Only 14% of physician practice representatives said their groups would contract with outside coding companies or hire more coders, compared with 69% and 53% of hospitals, respectively. The researchers noted that practices and other small organizations would rely more on additional training of their current staff.

In assessing the long-term impact of ICD-10, a plurality of respondents perceived some benefits in the areas of quality and safety measurement, health information exchange, clinical research, and population health management. But 48% of respondents said ICD-10 would make it harder to document patient encounters, and 68% said it would be more difficult to code encounters with ICD-10.

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