Updated on: March 16, 2016

New ICD-10 HBMA Survey Reveals Slow Progress, Lingering Concerns

Original story posted on: February 25, 2015

Healthcare Billing and Management Association (HBMA) completed its third ICD-10 readiness survey on Sunday, Feb. 22. According to our members, at least, there continues to be good news and bad news.

It is not surprising that our findings mirror some of those we have heard about from numerous other organizations. The same successes are starting to be reported but, disappointingly, the same challenges remain after also being reported during our last two surveys, conducted in the spring and fall of 2014.


In all three surveys, 80-plus companies responded (88 in this new survey). Company size ranged from fewer than 25 employees to more than 300. Participants bill for office-based physicians (25 percent), hospital-based physicians, multiple types of providers, and specialties including facilities, ASC, DME, ambulance, etc. Fifty-eight percent of respondents bill in more than one state, with 19 percent billing in more than ten. Both proprietary and commercial practice management systems are relied upon by respondents, and almost all of them submit claims through clearinghouses, as well as directly to payors. Coding is performed internally by coders who rely upon the medical record, by clients, outsourced, computer-assisted, and accomplished through the use of an electronic health record (EHR). Many companies have combinations or all of the above methodologies in use.

Mirroring other anecdotal reports, 24 percent of respondents reported that their practice management software has not been fully updated for ICD-10. Of those responding, 36 percent have no date certain regarding when it will be ready. These findings are virtually unchanged from our previous surveys. To add to that concern, 7 percent of respondents reported that their system does not handle dual ICD-9 and ICD-10 coding, and 17 percent still do not know if they will be able to accommodate both sets of codes. 

Also, a new practice management system inquiry specific to denial management appeared in this survey. To our knowledge, it is the first survey to explicitly ask if software is capable of ICD-10-specific denial management reporting. Although 48 percent of the respondents answered in the affirmative, 12 percent responded in the negative and 33 percent said they do not know if that capability does or will exist. Given the generally accepted understanding that denials will likely increase for some period of time following ICD-10 implementation, the ability to rapidly identify and address ICD-10 issues as soon as they arise is imperative.

Testing is clearly accelerating, although it appears to remain predominately associated with syntax. Eighty-four percent of respondents indicated that no end-to-end testing has been conducted, and 75 percent have no dates for end-to-end testing scheduled. Although syntax testing appears to have been very successful to date, concerns regarding payment disruptions will only be identified or allayed though end-to-end testing, which mirrors the real claims processing process.

The very good news is that the Centers for Medicare & Medicaid Services (CMS) Medicare Administrative Contractor (MAC) end-to-end testing was deemed much more successful in January 2015 than it was in November 2014, as a total of 71 percent of respondents reported successful testing (compared to 57 percent in November). Clearinghouses are actively engaged in testing as much as possible, and their experiences are also being communicated to our members.

Our members often report that their biggest impediment to readiness is their clients. This appears to be due to a combination of factors, including receptiveness, uncertainty regarding an implementation date that may or may not change, coding challenges, documentation deficiencies, etc. Given the fact that our members are in the trenches and are the revenue cycle experts, this survey does present some concerning findings regarding readiness confidence. In October, 45 percent of our members indicated that they were confident they were or would be ready for ICD-10 implementation. That number is now only 38 percent. Those who are somewhat confident have remained stable at 51 percent, and the previous 4 percent who were not confident has now grown to 11 percent. Clearly this is not a trend we want to see. It is likely that these negative trends are due to the issues described above, in addition to myriad other industry pressures.

Also consistent with the findings of other physician surveys, only 9 percent of our clients oppose another implementation delay. Sixty-one percent support another delay, although this is down from 75 percent in 2014. Nine percent of our clients are neutral, and 21 percent did not report an opinion. These findings are not surprising, when ICD-10 is just one more issue in the never-ending flow of regulatory changes, requirements, expenses, and operational pressures. 

In summary, the good news is that successful testing is slowly increasing and slow progress continues. The bad news is that it is not happening nearly fast enough. Some practice management system vendors do not appear to be as ready as promised, a situation that could threaten the viability of some practices, in a worst-case scenario. And yet again, we hear that the majority of physicians would support additional delays. How we, the industry, can help them succeed must assume a much higher priority for us all to be successful. In spite of dedicated efforts by CMS and other organizations, we have physicians who continue to have significant challenges.  If the percentage of physicians struggling was tiny, this might be far less significant, but repetitive findings of 50-plus percent indicating that ICD-10 will be terribly disruptive to their practices and that they are supportive of another delay should not be ignored. 

HBMA is ready and able to continue working with all stakeholders, especially our physicians, to ensure that ICD-10 will be successful. Let’s all work together to find workable solutions.

Holly Louie, RN, BSN, CHBME

Holly Louie is the compliance officer for Practice Management Inc., a multi-specialty billing company in Boise, Idaho. Holly was the 2016 president of the Healthcare Business and Management Association (HBMA) and previously chaired the ICD-10 Committee. Holly is also a national healthcare consultant and testifying expert on matters related to physician coding, billing, and regulatory compliance. She has previously held compliance officer positions in local and international billing companies. Holly is a member of the ICD10monitor editor board and a popular guest on Talk Ten Tuesdays.