Providers Falling Behind on ICD-10 Readiness

The Workgroup for Electronic Data Interchange (WEDI) sent a letter to HHS Secretary Sylvia M. Burwell on March 31 explaining that the 1-year delay for implementation of the International Classification of Diseases, Tenth Revision (ICD-10) may have done more harm than good.

Based on survey responses from 1174 providers, vendors, and health plans, the delay had a negative impact on some readiness activities. While they were given more time, it appears that many organizations did not take advantage of the extra time, according to the letter.

“Unless all industry segments take the initiative to make a dedicated effort and move forward with their implementation work, there will be significant disruption on Oct. 1, 2015,” Devin Jopp, EdD, president and chief executive officer of WEDI, said in a statement.

End-to-end testing by CMS claims found 81% of ICD-10 claims received were accepted, and that the majority of rejected claims were for reasons unrelated to ICD-10. However, WEDI’s survey results tell a slightly different story.

While more than 50% of health plans have begun external testing, only a few have completed testing. In addition, only 25% of providers have begun external testing, which is actually a decrease from the 35% of respondents in the August 2014 survey.

“Based on the survey results, it appears the delay has had a negative impact on some readiness activities—especially external testing,” Jim Daley, WEDI past-chair and ICD-10 Workgroup co-chair, said. “Uncertainty over further delays was listed as a top obstacle across all industry segments.”

However, an even larger challenge was competing internal priorities, according to three-fifths of respondents. In comparison, concerns over vendor readiness, other regulatory mandates, and staffing are now less pressing.

Overall, while health plans continue to make some progress, although testing efforts have slowed, providers appear to be falling behind, according to the survey results. More than one-quarter of provider respondents said they do not expect to begin external testing until the second or third quarter of 2015, and more than one-third still does not know when they will begin testing. Plus, while three-fifths of hospitals and health systems have completed impact assessments, less than one-fifth of physician practices have done so.