Survey: Only 61% of healthcare payers say they will be ready for ICD-10

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Many third-party payers believe they won't meet the 2014 deadline for ICD-10 compliance, a new study shows. That could be a problem for your practice.

You and your fellow physicians aren’t the only ones who are behind in preparing for implementing ICD-10, the latest iteration of the International Classification of Diseases and Related Health Problems. Many of your payers are, or think they will be, in the same situation-and that could spell trouble for your practice’s finances.

A recent survey by HealthEdge, a provider of software to healthcare payers, found that only 61% of healthcare payers believe they will be ready to meet the deadline for ICD-10 compliance, despite the deadline’s having been extended recently from October 2013 to October 2014.

“Doctors need to be prepared for a slowdown in claims payments,” says Virginia Martin, CMA, CPC, of Healthcare Consulting Associates of N.W. Ohio Inc., and a Medical Economics editorial consultant. “They need to be sure they’ve put some money aside to get through this.

“The other issue is to be sure [doctors] are prepared internally to report the correct codes, and that goes back to documentation,” Martin adds. “You can’t assign the code without the documentation.”

Ray Desrochers, executive vice president of HealthEdge, tells Medical Economics that many third-party payers have underestimated the challenge of preparing for ICD-10.

“A lot of them thought early on that it would be a minimal amount of work, that all they had to do was load the new code set and life would be good,” he says. “As they began looking at it more, they saw that not only are we going from 17,000 diagnoses and procedure codes to 155,000, but the 155,000 are longer, more complex, and a lot of other characteristics their systems won’t support.”

Desrochers adds, however, that more payers likely will become ready as the compliance date approaches, and that payers overall will be more likely to meet the deadline than providers, especially those in small practices. “We’re more worried about the small providers not being able to get their changes done in time and that there will be chaos in the system because they’re going to feed ICD-9 codes, or do some hybrid of 9 and 10,” he says.

Martin believes a strong possibility exists that the compliance deadline could be extended even beyond October 2014. “The [American Medical Association] is lobbying [for an extension] due to all the changes coming in practices, with meaningful use the requirements for electronic health records, and so on,” she says. “This is just one more issue practices have to deal with.”

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