After being delayed in 2009, 2012 and 2014, the nation's switch to ICD-10 is once again slated to occur this October. Although the industry has had years to prepare, the negative effects of the switch may be felt by all providers, even those that believe they are fully ready for the new coding system.
Even with all of the ICD-10 delays, many providers may still not meet the Oct. 1 deadline. An April survey of 1,100 organizations found more than half of respondents were uncertain of the actual ICD-10 deadline and more than half had not yet completed end-to-end testing. Additionally, a June survey of 271 providers from eHealth Initiatives, Greenway Health and AHIMA found only 34 percent of respondents had completed internal testing and only 17 percent had completed external testing.
In April, Jim Daley, past-chair of The Workgroup for Electronic Data Interchange and ICD-10 workgroup co-chair, said uncertainty about future delays is one reason some providers have lagged behind in their ICD-10 preparation. Although another three months have passed, some providers still believe the switch to ICD-10 isn't going to happen this year.
Regarding the October deadline, RelayHealth ICD-10 Director Joshua Berman says "the chances of another delay are very low." Mr. Berman cites a number of reasons why he believes ICD-10 will not be delayed again, including how difficult it would be to get a bill pushing the deadline back through Congress before October. Politics could also play a role in the switch occurring this year. "This is an off-election year, and if I was a politician, I would roll ICD-10 out during an off-election year rather than delay it," says Mr. Berman.
Provider organizations that haven't adequately prepared for the switch are going to have issues with the processes that ICD-10 requires. However, Mr. Berman noted even organizations that have prepared may still have problems. "We've done between 120,000 and 130,000 test claims, which is by far more than anyone else in the industry. We haven't been able to achieve that anyone is prepared based on that testing," says Mr. Berman.
That finding is mostly due to the processes ICD-10 requires. "Traditionally, in our business, we look at all changes as technology changes. This isn't a technology change, it's a process change," says Mr. Berman. The switch to ICD-10 requires coding staff, physicians and all others who document conditions to be properly trained to ensure billing is done correctly.
All providers are likely to encounter some issues with the switch to ICD-10, including an increase in claim denials and the amount of time it takes payers to process claims. However, organizations that have done the necessary testing and invested the time and resources into properly educating and training coding staff, physicians and others, are going to fare better when the switch occurs.
To help ease the burden of the switch, CMS provided additional ICD-10 guidance in July. CMS announced a number of changes, including a one-year transition period. During that time, providers' Medicare claims will not be denied or audited solely based on the specificity of diagnoses codes as long as they still come from the appropriate family of ICD-10 codes.