Health IT

Providers Lagging on ICD-10 Transition Plans

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Hospitals and physician offices are behind schedule in preparing for the transition to the ICD-10 coding system, according to a recent Workgroup for Electronic Data Interchange (WEDI) survey.

Unless providers move quickly, the February survey results hint at problems occurring on Oct. 1, 2014, which is the date the Centers for Medicare & Medicaid Services (CMS) has set for the transition. On that date, payers can no longer process claims using the current coding system, ICD-9.

“The entire industry is not where it should be overall,” said Jim Daley, chair of WEDI, co-chair of the WEDI ICD-10 Assessment Workgroup, and director of information technology at BlueCross BlueShield of South Carolina.

“Certainly select organizations have moved along very well; the larger the organization, the…further ahead they are. Payers are much further along” than providers, Daley told HealthBiz Decoded.

According to the survey, two-fifths of providers said they did not know when they would complete their ICD-10 impact assessments, and half responded that they did not know when they would begin external testing of their ICD-10 systems.

ICD stands for the International Classification of Diseases, which is the system that the World Health Organization developed to categorize diseases. The ICD-9 coding system has about 18,000 different codes. The ICD-10 coding system, in contrast, has about 141,000 codes; they are more detailed and nuanced than the ICD-9 ones and use longer strings of letters and numbers.

Other countries have been using their own versions of ICD-10 for several years to code diagnoses. Hospitals and physicians in the United States, however, still use ICD-9, which is about 35 years old, to code diagnoses and in-patient procedures.

Providers Grappling with Competing Priorities

Several reasons account for the sluggish pace of provider preparations for the new coding system, says Erik Newlin, co-chair of the WEDI ICD-10 Transition Workgroup and director of National Standards Consulting for Xerox.

First, CMS pushed back the date of the transition to October of next year, leading many hospitals and physician offices to get a mixed message from CMS on its commitment to ICD-10.

“The fact that CMS created a delay from the original deadline of Oct. 1, 2013, sent a confusing message,” said Newlin. Providers “didn’t know what to think.”

Calls from the American Medical Association (AMA) and other medical organizations for the postponement of ICD-10 also add to provider confusion about ICD-10, he said.

In fact, the AMA and several other medical organizations – including the American Academy of Family Physicians, the American College of Cardiology and numerous state medical associations – sent a letter to the CMS last December urging them not to require providers to switch to ICD-10, citing the cost and technical challenges.

Another factor is that hospitals and physicians are preoccupied with other matters, such as complying with CMS requirements for Meaningful Use of electronic health records.

Finally, said Newlin, transitioning to the new coding system will be expensive. Providers have to pay for training medical coders, upgrading electronic health record systems, and diverting information technology staff from other projects to the ICD-10 transition.

Despite the obstacles to making the transition, it’s important that they do so, he emphasized. The precision of the ICD-10 coding system will improve reimbursement accuracy and provide more data on diagnoses and procedures, he said.

Easing the transition period?

In light of survey results showing that hospitals and physicians may not be ready by next October, payers should be thinking now about how they will respond if providers aren’t ready by that date.

Although CMS has said that Oct. 1, 2014, is a firm cutoff date for ICD-9, Newlin said he hopes CMS will reconsider and allow payers to accept claims coded in either ICD-9 or ICD-10 for a few months after the official switchover date. A stretched-out transition period would soften the bumps and give providers more tools to avert service disruptions, he said.

“It would easier if CMS gave [health plans] the latitude early on to embrace dual processing,” said Newlin.

“We need the benefits of ICD-10, but we can’t afford to have the entire health care ecosystem stop,” he said.

CMS says it believes the one-year extension through next October should give physicians enough time to make the switch. Citing many industry comments in favor of the extension, the agency says the decision strikes a good balance between providers concerned about meeting the original deadline and those that had already begun to implement the changes.

Daley of WEDI said that payers should monitor the transition and “plan to mitigate any risks.”

Daley suggested that providers who are behind on their transition plans do an impact assessment as soon as possible. “Find every place you use or store a diagnosis or procedure code. Until you find those, it is difficult to understand how big the impact is and what the effects are going to be. Once you have those, you can plan accordingly.”

Second, he recommended that providers discuss the transition with their vendors. They may think that vendors are taking care of all the details, but that may not be the case. Finally, Daley recommended that providers visit the CMS and WEDI websites for information and resources.

“WEDI is putting together a roadmap and other resources. There is a lot of stuff out there already. You don’t have to reinvent the wheel,” Daley said.