Edifecs, eHI and AHIMA Survey Reveals ICD-10 Readiness Concerns Remain, But Some Optimism Over Long Term Value

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Deadline Extension Being Used for Improved Documentation, Training & Testing

Edifecs, a global health information technology solutions company, sponsored an ICD-10 preparedness survey revealing a majority of healthcare organizations impacted by the mandate are using time afforded by an extended compliance deadline to invest in clinical documentation improvements, workforce training and partner testing, yet concerns over readiness and financial impact remain. Despite the challenges in the short term, most expect the more specific code set to return value in the long run. The survey was conducted by eHealth Initiative (eHI) and the American Health Information Management Association (AHIMA).

While the majority of organizations are ready to begin testing for ICD-10, there are varying timelines, indicating some are more prepared than others. Forty-five percent of respondents don’t have a good sense of their partners’ readiness.

Key preliminary findings from the survey include:

  •     Most organizations are prepared to begin testing in the near future. Forty percent of respondents reported they would begin end-to-end testing by the end of 2014, and 25 percent reported plans to begin by the end of 2015. Of those who stated they had no plans for end-to-end testing, however, 41 percent stated they had no knowledge of how to perform testing.
  •     Widespread concern about the impact of ICD-10 on workflow, productivity and revenue. Thirty-eight percent of respondents reported they believe revenue will decrease, while 14 percent believe revenue will remain neutral. Only six percent believe revenue will increase.
  •     Optimism that increased specificity can improve research, population health management and quality/performance measurement and improvement. Respondents answered that common activities like coding patient encounters, adjudicating reimbursement claims and negotiating contracts between health plans and providers are expected to be more difficult in the short term. Although the long-term impact of the ICD-10 transition is expected to improve care in areas such as accuracy of claims, quality of care and patient safety, not all organizations have a clear plan to derive value from the expanded code set.
  •     Extensions represent an opportunity for additional training. In order to mitigate productivity loss, 68 percent of respondents stated they plan to conduct additional training and practice, and 31 percent plan to hire more coders to assist with the transition. More organizations are also taking advantage of the compliance extension by training more staff for ICD-10 and improving clinical documentation integrity.
  •     Clinical documentation integrity is expected to be more difficult. Respondents indicated the task that is expected to be the most difficult post ICD-10 transition is clinical documentation improvement, particularly documenting and coding patient encounters. About 61 percent of respondents report planning to utilize the extension to improve clinical documentation integrity.
  •     Organizations expect to leverage increased code specificity for claims processing and billing, performance measurement and quality improvement. Respondents stated they plan to leverage the more specific code set for claims processing and billing (65 percent), quality improvement (62 percent) and performance measurement (51 percent).

“These results show that 'prime time' for ICD-10 preparedness is now through spring 2015. Testing is vitally important to establish readiness for the ICD-10 transition, and to mitigate any potential revenue impacts,” said Sunny Singh, CEO of Edifecs. “Although the mandate has created uncertainties and challenges for all, there is the strong potential for our customers to benefit from improved claims processing and billing, performance measurement, and information quality improvement."

About the survey:
Survey respondents included vendors, payers, clinic and physician practices, acute care hospital representatives, and consulting firm representatives among others. The survey, to date, was distributed to a variety of stakeholders in May/ June 2014 and returned 349 responses. Areas of focus included readiness for testing and implementation, financial, operational and clinical impact of ICD-10 and strategic implications of the expanded code set.

About Edifecs, Inc.
Edifecs is a leader in developing innovative, cost-cutting solutions to transform the global healthcare marketplace. Since 1996, Edifecs has provided technology that automates many administrative functions in order to trim waste and reduce costs as well as increase revenues, collaboration and operational performance. Customers who have benefited include healthcare providers, insurers, pharmacy benefit management companies, and other trading partners. More than 250 healthcare customers today use Edifecs solutions to simplify and unify financial, clinical and administrative transactions. They also use Edifecs technology to automate manual business processes (e.g., enrollment, claims and payments management) and to support compliance for HIPAA, Operating Rules and ICD-10 mandates. In addition, Edifecs develops supply chain management solutions to support worldwide customers in non-healthcare industry segments. Edifecs is based in Bellevue, WA, with operations internationally. Learn more about us at edifecs.com.

The American Health Information Management Association (AHIMA) represents more than 71,000 educated health information management professionals and health informatics in the
United States and around the world. AHIMA is committed to promoting and advocating for high
quality research, best practices and effective standards in health information and to actively
contributing to the development and advancement of health information professionals
worldwide. AHIMA’s enduring goal is quality healthcare through quality information.

About eHealth Initiative
eHealth Initiative (eHI) is a Washington D.C.-based, independent, non-profit organization whose mission is to drive improvements in the quality, safety, and efficiency of healthcare through information and information technology. eHI is the only national organization that represents all of the stakeholders in the healthcare industry. Working with its membership, eHI advocates for the use of health IT that is practical, sustainable and addresses stakeholder needs, particularly those of patients. For more information, visit http://www.ehidc.org.

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