For several years, surveys conducted by industry organizations such as the American College of Healthcare Executives revealed ICD-10 as one of healthcare leaders’ top priorities. However, these surveys didn’t explore the details of providers’ ICD-10 attitudes, planning, and progress as they neared implementation. Through a series of three surveys of physician practices, conducted from 2013 to 2015, Navicure has gained insights regarding practice leadership teams’ thoughts in this area. Here are five key findings from the latest survey, which was conducted in January 2015:

1.  Timing may be everything…but momentum is, too.

When the Protecting Access to Medicare Act was signed into law on April 1, 2014, prohibiting the Centers for Medicare & Medicaid Services (CMS) from implementing ICD-10 before Oct. 1, 2015, a total of 58 percent of practices surveyed “pressed pause” on their planning efforts. In January 2015, just less than 25 percent of respondents indicated that they had continued their preparations as usual despite the delay – while another 16 percent still hadn’t begun preparing at all.

The additional year has afforded providers more time for significant initiatives such as testing and training; however, pressing pause may have stymied momentum. This momentum loss may be why nearly as many respondents noted that the delay had a negative financial impact (13 percent) as those who said it had a positive one (20 percent). Given the many aspects of ICD-10 readiness, building and sustaining momentum can be the difference between success or unpreparedness. During these final months leading to October 2015, it is important to have a plan that keeps ICD-10 at the forefront for physicians and staff. By reminding physicians and staff of the critical importance of being prepared for ICD-10, frequently providing ICD-10 transition updates, and ensuring that physicians and staff receive timely training, you can help your team build upon their knowledge and stay focused despite their many other responsibilities.

2.   The state of ICD-10 preparedness varies widely, but optimism reigns.

Only 21 percent of respondents think that they’re on track with ICD-10 transition plans; however, 81 percent are optimistic that they’ll be ready by Oct. 1, 2015.

Among the practices that haven’t yet started ICD-10 preparations, one-fourth are waiting for their practice management or electronic health records vendors to make software updates. Another 23 percent of respondents indicated that they don’t have the time, staff, or resources to begin preparing. With only a handful of months remaining, providers should review their original ICD-10 transition plans and revise them according to what’s most critical – and what’s realistic. A good first step is to identify the ICD-9 codes that are most frequently used (and which generate the most revenue within your organization) so there is an understanding of how these codes will be translated to ICD-10 well ahead of the transition. This activity can help focus your planning efforts and ensure that your team is comfortable with your organization’s most important ICD-10 codes.

3.  Another delay? The majority of practice leaders don’t think so. 

Despite some activity in late 2014, Congress has not yet passed legislation to delay the ICD-10 transition. Two-thirds of the survey respondents believe that the transition date will remain Oct. 1, 2015.

As October 2015 draws closer, respondents’ confidence in their readiness has dropped. In Navicure’s November 2013 survey, more than 87 percent of respondents were confident they’d be ready for the Oct. 1, 2014 transition date – and in the 2015 survey, this percentage decreased slightly, to 81 percent. During these final months, the ICD-10 transition plans providers created 18 months ago may seem dated. To remain on track, providers may want to focus on prioritizing a truncated timeline for preparation efforts.

4.   What keeps practice leaders awake at night? ICD-10’s potential impact on revenue and cash flow. 

Nearly 60 percent of survey respondents are most concerned about ICD-10’s impact on their practices’ revenue and cash flow. A distant second was staff productivity, which 12 percent of respondents listed as their top concern. These findings aren’t surprising; any one component of an ICD-10 plan can impact revenue or productivity. Regardless of your organization’s progress, however, conducting readiness planning and being aware of what could go wrong on Oct. 1 can safeguard your cash flow. Contingency plans that address scenarios such as coding backlogs can help you be prepared for any situation – thus preserving revenue during the initial weeks of the transition.  

5.   Practices cite payer unpreparedness as their greatest ICD-10 challenge.

While respondents cited training as their practices’ greatest challenge in the first two surveys, 41 percent of respondents in the January 2015 survey cited lack of payer readiness as the most challenging aspect of the transition. Payer readiness has likely emerged as the top challenge because many practices haven’t conducted testing yet. The time remaining to test is dwindling, and just 49 percent of respondents are currently performing end-to-end testing or have plans to do so. Ten percent of respondents indicated that they definitely won’t participate in end-to-end testing. 

While end-to-end testing with payers is the ideal way to determine readiness, organizations can conduct internal testing if end-to-end testing is not an available option. While providers may not be able to achieve complete peace of mind regarding payer readiness, they can control numerous other factors that contribute to a successful transition: vendor updates, process changes, coding and clinical documentation updates, and comprehensive training. Taking charge of what you can control will pave the way for a smoother transition.

The good news: exhibiting a healthy dose of optimism regarding readiness can boost momentum and keep attitudes positive during an intense transition period. The not-so-good news: providers seem to be lagging in areas such as testing and day-to-day planning, which may lead to problems on Oct. 1. Fortunately, there’s still time remaining to get ICD-10 plans on track. By regrouping, determining the critical areas of focus, and using the many resources available, providers can be ready by the time implementation arrives and protect their organizations’ financial health in the process.

About the Author

Ken Bradley is the vice president of strategic planning and regulatory compliance at Navicure, a provider of cloud-based healthcare billing and payment solutions.

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