In the final of a series of surveys assessing the ICD-10 readiness of physician practices, claims clearinghouse Navicure finds much work remains yet respondents may be too optimistic of being prepared.
Further, Navicure CEO Jim Denny worries that insurers are woefully unprepared for what’s coming.
Porter Research conducted the random survey of 318 practices in August. Practice specialties and sizes varied, but two-thirds of respondents came from practices with 10 or fewer physicians. Survey results consistently show serious disconnects between the reality of where a practice was with preparations and where it expects to be come October.
In August, for instance, only 43 percent of respondents indicated their organization was on track for the compliance date but 85 percent were optimistic they would be prepared by October 1. A comparable survey in January 2015 found the same disconnect, as 82 percent of respondents were optimistic about being ready in time while only 21 percent said their practice was currently on track to meet the deadline.
With many surveyed practices not in an optimal position yet, 56 percent cited ICD-10’s impact on revenue and cash flow as their greatest concern. Almost all practices anticipate an increase in claims denial rates but only 30 percent have improved their denial management processes. More than a third had not adjusted their revenue at all, such as improving patient price estimation and patient collections.
The biggest challenge of ICD-10, according to practice administrators, billing managers, other practice executives, and billers and coders who responded, is increased clinical documentation updating and coding requirements. Still, 46 percent estimate productivity losses of less than 20 percent and one-fifth don’t expect any productivity loss.
Medicare’s decision to accept technically incorrect ICD-10 codes for a year as long as a selected is from the appropriate family of codes, as well as its readiness to authorize advance payments if Medicare contractors have difficulty processing claims, isn’t making practices feel more secure, as half of respondents said they don’t feel less concerned about revenue impacts.
Only one-quarter of respondents did end-to-end testing with payers with 60 percent of these testers having expected or positive results.
Navicure and other vendors have done a lot of work updating software and educating many thousands of provider clients through webinars, seminars and other events. CEO Jim Denny wonders if once providers feel well about the status of their updated information systems, they may underestimate the scope of internal training and other tasks, and that could help explain the disconnect between current readiness and optimism that they will be ready.
Denny’s biggest concern, however, is payer readiness. The total number of claims tested in preparation for ICD-10 has been miniscule at best, he believes, particularly with Medicare testing. When the industry transitioned to the HIPAA 5010 transaction sets, it was much more difficult than expected because not enough testing was done and the sheer volume of transactions when 5010 went live overwhelmed processing systems, he recalls. And ICD-10 is a lot bigger.
The worry, Denny says, is that individual payers tested hundreds or a few thousand claims in getting ready for ICD-10, but what will happen when their systems start processing millions of claims?
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