For small physician practices, it's often out of their hands when it comes to ICD-10 readiness. It's not necessarily because the physicians at these smaller practices haven't put in the time to get proper training and become familiar with the codes. Instead, it's frequently because the vendors aren't ready and don't have an ICD-10-compliant product to offer their clients, leaving many practices in the lurch.
Take David Heck, M.D., and the small practice he is a part of, for example. In addition to being the chief of orthopedic surgery at the Methodist Dallas Medical Center, Heck is also an orthopedic surgeon who focuses on total joint replacements. His practice, Texas Orthopaedic Surgical Associates in Dallas, consists of six orthopedic surgeons -- including Heck -- and one podiatrist.
Although they've done their best to prepare for ICD-10, Heck said his practice has run into ICD-10-related technological problems and uncertainties.
For instance, the small orthopedic practice's EHR and billing software vendors -- which Heck declined to name -- "have yet to complete a test between our EMR software and our billing software … We have been told by our billing software that we must go live in order to be able to test; we can't create a sandbox platform."
And once they go live, Heck explained, there's no going back. "That's not comforting," he said.
ICD-10 testing not mandated for vendors
Another obstacle to practices' ICD-10 readiness is the vendors. Heck said their EHR vendor has not been able to fully implement ICD-9 codes, never mind ICD-10. "I think I could say with a high level of confidence that the ICD-10 implementation that they will come forward with is likely to not work," he added.
Finally, on top of all of that, Heck said the American Academy of Orthopaedic Surgeon's Code X software that the practice uses to help with the coding process is not yet functional at the ICD-10 level.
"A lot of the ability to be ready is out of the hands of the physicians themselves," said Robert Tennant, senior policy advisor of government affairs at the Medical Group Management Association (MGMA) in Englewood, Colo. "[Heck] may have gone through countless hours of training, he may be well versed on the codes, but if he's unable to include the code in his software to allow it to be included in the claim going to the insurance company, then they're out of luck."
Heck said his practice has gone for initial EHR training, as well as direct ICD-10 training, and has participated in webinars. He added that the practice also spent two nights -- around six hours total -- to go through a comprehensive specialty focus in order to better understand the ICD-10 coding system and some aspects of implementation. But because the software and services the practice needs to submit claims with ICD-10 codes are not ready or have not been tested, Heck's practice remains in a tough spot.
David Heck, M.D.Texas Orthopaedic Surgical Associates
"Keep in mind [that] when the government mandated ICD-10, it mandated it on what are termed covered entities under HIPAA. So, that is three entities: health plans, clearinghouses and providers. That includes inpatient and outpatient providers," Tennant said. "What [the government] didn't do was mandate ICD-10 on vendors … and some [vendors], perhaps, may never offer a compliant solution."
Ironically, the government has issued ICD-10 waivers to four state Medicaid programs that will not be ready for the transition to the new coding set on Oct. 1, 2015.
Without vendor ICD-10 readiness, submitting a claim is still possible
For those practices stuck with a vendor that has yet to offer an ICD-10-compliant product, it won't be impossible to submit a claim, Tennant said, because practices can still manually submit ICD-10 codes through a Web portal of a health plan.
However, this approach can be time consuming. "I think the overall problem is that it's going to really drive down productivity, which is already impeded," Tennant said.
For Heck and his practice, "it's going to require a lot of man hours to be able to provide ICD-10 specificity and crosswalks to CPT. That work has yet to be performed," Heck said. "So, we're going to have to [find]… alternative methods of trying to comply with the ICD-10 coding system."
Lack of vendor ICD-10 readiness felt across the board
The challenges Heck's practice is experiencing are not unusual. A physician practice assessment conducted by MGMA in February 2015 found that 17% of respondents said internal ICD-10 testing has started with their practice management vendor, but was not yet complete. And 42% said they still do not know when their vendor will begin internal testing.
Furthermore, 40% of respondents said they have not heard from their clearinghouse regarding when they will be ready to accept test claims, while 15% said they have fully tested with their clearinghouse.
Read more about ICD-10:
With internal ICD-preparation, providers mostly satisfied
ICD-10: End-to-end testing mostly free of coding errors
Governance, end user buy-in leads to successful ICD-10 implementation