Updated on: March 16, 2016

Get Moving Now, Avoid the Testing Gridlock

Original story posted on: February 25, 2014

Ana Croxton is worried about gridlock. And has good reason to be since she works in Atlanta, the city that was brought to its knees three weeks ago when two inches of snow and ice blanketed highways and freeways.

She’s not worried about the kind that happens on the highway during a bad snowstorm when everyone is trying to get to their destinations at the same time. Croxton is worried about the kind that will occur if too many providers wait to perform ICD-10 end-to-end testing.


Croxton, vice president EDI Products and Services, NextGen Healthcare, expanded on this analogy and shared information about the role of clearinghouses on the February 25 Talk-Ten-Tuesday broadcast from the HIMSS conference.

“What are you waiting for?” It’s a simple question that Ana asks providers, especially physicians, and payers who are still hoping that the October 1, 2014, ICD-10 implementation deadline will just “go away.” She reminds them that “it’s a reality,” but still she sees a lack of activity, and this also worries her.

Denny Flint,chief executive officer of Complete Practice Resources, is not so worried, but he is frustrated. In fact, he told Talk-Ten-Tuesday listeners that he wanted to throw an “old-fashioned tantrum” and wondered what he had to do to “get people to pay attention?”

He gave this example as a source of his frustration. He attended an orthopedic conference where he was conducting ICD-10 training for an audience of 150 physicians, and a hospital-sponsored symposium that 250 physicians attended. When asked to raise their hands if they had started to get ready for ICD-10, only five out of the total 350 did so.

Flint said that many physicians believe that their EHR vendor will handle their transition to ICD-10. When he asks EHR vendors whether they’re ready, they say that they’re “barely ready for meaningful use, stage 2, and we’ve yet to get to ICD-10,” he says.

Mark Lott, chief executive officer of the Lott QA Group, agrees with Flint and Croxton that physicians and EHR vendors are still waiting for “someone else” to take care of them. That’s not going to happen because, as he said, “CMS and payers are only going after the largest submitters.”

Sean Kilpatrick, product manager from the clearinghouse Availity, agrees that smaller physician groups and hospitals are the primary at-risk providers.

“The major healthcare systems have contingency plans and testing in place,” he says. “For smaller markets, it seems to be out of sight, out of mind.”

The hope is that small physician practices and hospitals will begin to contact their payers and, as Lott advises, “insist on testing, especially those that rely 100 percent on Medicare and Medicaid reimbursement.”

Also, anyone who hasn’t done so yet should “reach out to their clearinghouses today and start talking to them about testing plans,” Croxton says. “You are putting your organization at risk if you don’t. The danger of not getting into an early testing cycle is that you’ll get caught in the middle of the pack and may not be able to test at all. If your vendor isn’t ready, you need to have a Plan B or C. Come June or July even these options might go away.”

Another thing to realize, said Lott, is that there is not enough time or resources for each covered entity to test with all their trading partners in order to properly the assess the impact of ICD-10 on workflow and revenue. This reality calls for collaboration among like entities.

“We can see that all hospitals are doing the same thing no matter their location. They are almost carbon copies,” Lott said. “If you take 100 orthopedics, they all do the same procedures. These groups are coming together and finding their commonalities and collaborating in the work that needs to be done.

Clearinghouses Can’t Do it All

“The ICD-10 transition is unlike prior regulatory changes, such as 5010, where clearinghouses could intercede. We can help with the transition, but we can’t do it all,” Croxton said. For example, “clearinghouses can’t help with mapping because there’s no 1:1 correlation. Physicians must supply the data.”

Kilpatrick adds, “The 5010 was more of a graceful transition period but not so with ICD-10. We all expect that the implementation date won’t move; we’re taking steps to be ready for contingencies just in case.”

The first step is to just start, said Lott.

“Most who are putting it [planning and testing] off see it as daunting. They have analysis paralysis. To get over that, just look at the simplest things you can do. Stop waiting for vendors to be ready. Just do what you can. Don’t get caught with a thousand things on your list. Take the top three and do them.”

What Happens If…

“Not everyone will be ready and able to make the date,” says Kilpatrick. “Because of that, we’re building into our systems to support Plan B, especially if waivers will be given to those who can’t make the date. If health plan can’t accept I-10, we’ll pass through I-9 and will support it. We want to ensure that providers continue to submit electronically and expediently.”

Everyone on the February 25 broadcast agreed that providers should be developing their own contingency plans, and Kilpatrick has several questions that he hopes they will answer:

  • What are you going to do when you don’t get all of the required upgrades from all vendors?
  • What policies need to be established to support dual coding?
  • What kind of support will your clearinghouses offer?
  • Does your plan include a way to meet payroll and pay bills?

Before and After the Deadline

The primary focus of last year’s HIMSS conference was the October 1, 2014, deadline. But, says Bonnie Cassidy,senior director of HIM Innovation at Nuance Communications, “this year they’re realizing that the deadline won’t be the end.”

According to Cassidy, conference attendees are thinking about business continuity and refocusing on data integrity. She’s hearing conversations about coding and coding audits, internal assessments, reeducation of coders, and the continuous QI model.

Those who are thinking that they need help now may want to visit http://www.himssconference.org/GenInfo/Index.aspx?navItemNumber=22266, which is the HIMSS conference website. Particularly useful could be the speaker handouts section. These materials will be available for 90 days, according to HIMSS.



Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for RACMonitor.com and ICD10Monitor.com; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.