date is still slow. The greatest concern is the lack of communication and critical coordination between physician prac- tices and their essential trading partners (such as claims clearinghouses, EHR ven- dors, and practice management system vendors) regarding software updates and testing, which have not yet occurred. Only 4.8 percent of practices reported making significant progress when rat- ing their overall readiness for ICD-10 implementation. The research includes responses from more than 1,200 medi- cal groups where more than 55,000 phy- sicians practice. MGMA research highlights the follow- ing ICD-10 readiness findings:
• More than 52 percent indicated they had not heard from their practice management system vendor about when software changes would be available. Almost 50 percent had not heard from their EHR vendor.
• Only 5.9 percent reported that inter- nal software testing has begun or is complete with their practice manage- ment software vendor and 4.7 percent with their EHR vendor.
• Just 11.9 percent said external testing with their clearinghouse has started or is complete. Almost 60 percent said they have not even heard from their clearinghouse regarding a test- ing date. Only 8.6 percent have start- ed or completed testing with their major health plans, with a worrisome 70 percent saying they have not heard from insurers.
• Nearly 60 percent said they are “slightly” or “not at all confident” their major health plans will be ready to meet the Oct.1, 2014, deadline.
• Among a number of implementation concerns, 88 percent are concerned or very concerned about the expect- ed changes to clinical documentation; 87.5 percent are concerned or very concerned about the loss of clinician productivity after implementation; and 81.1 percent indicated they are concerned or very concerned with the overall cost of switching to ICD-10.
• Only 32.5 percent report that their vendor will cover the cost to upgrade or replace their practice management
26 TEXAS MEDICINE October 2013
system software. Only 37 percent say their vendor will cover the cost to up- grade or replace their EHR.
• For those organizations that must cover the costs themselves, the aver- age cost for a 10-physician practice to upgrade or replace their practice management system and EHR soft- ware to accommodate ICD-10 is $201,690.
John Burns, a National Alliance of Medical Accreditation Services instructor and American Health Information Man- agement Association (AHIMA) ICD-10 trainer, says you and your staff should be immersed in ICD-10 training by now. “ICD-10 implementation will impact all aspects of the revenue cycle. It starts with patient registration and doesn’t stop until the payment has been pro- cessed,” he said. You should inquire about ICD-10
training opportunities from your EHR vendors, as well. Greenway Medical Technologies, for example, trained cus- tomers through ongoing regional and online educational sessions. The EHR vendor also held a customer conference in August to bring clients up to speed on ICD-10.
Physicians who haven’t started pre- paring for ICD-10 shouldn’t panic. Mr. Burns says it’s not too late to get started. “Physicians should start by working with their staff to run a utilization report of the 50 to 100 most frequently used ICD-9 codes. They should then cross-ref- erence those codes with the ICD-10-Clin- ical Modification manual to see how the structure of the codes differs,” he said. He encourages you to jump on the
ICD-10 bandwagon to begin managing training and implementation processes internally. (See “CMS Impact Assessment Checklist,” page 24.)
“Practices that have done nothing be-
fore the implementation deadline next year won’t get paid. That could result in their financial ruin, so it’s important for physicians to take this seriously,” Mr. Burns said.
Challenges, “potential glory” Eric Weidmann, MD, an Austin family physician and a member of the TMA
Council on Practice Management Ser- vices, believes ICD-10 will yield public health and safety benefits down the road. “The potential glory in using a more specific code set is the ability for us to have research data that can be tracked and used to improve policies and guide- lines that affect certain patient popula- tions,” he said. For example, he says data collected
through ICD-10 on facial contusions from automobile collisions could result in improved guidelines for airbags and other safety features. That said, he’s well aware of the administrative burden ICD- 10 denotes. Like many physicians, Dr. Weidmann envisions financial hassles with payers when the ICD-10 switch oc- curs next October. “We’re expecting some cash flow hic- cups next year. It’s on my radar to ensure we have a line of credit available to han- dle the blow to the practice’s finances,” he said. Mr. Burns suggests practices plan ahead and take appropriate measures in case of financial disruption next fall. He says payers and practice management system vendors will likely have some technological bugs to sort out that could delay payments to practices. “If some payers are unable to pro- cess claims or recognize the new codes, it will lead to a spike in claim denials for practices. Physicians should have a well-established line of credit with their lenders to ensure they can make payroll, cover overhead, and keep the business running,” Mr. Burns said. Dr. Spencer anticipates ICD-10 train- ing will cost the practice in terms of staff time spent learning a new system. AHIMA estimates coders should devote an average of 16 hours of training on ICD-10 diagnosis coding and 10 hours on additional practice. Dr. Spencer has concerns about the changeover to a new coding system and its impact on his business. “We’ve operated without a high-level
professional coder, but we may need to allocate resources to hire one full-time. We have to ensure we’re correctly sub- mitting clean claims or else the practice will suffer financially,” he said.
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