Updated on: March 16, 2016

We Took a Step Back – and Fell Off a Cliff

Original story posted on: June 16, 2014

At numerous meetings since the ICD-10 delay was announced, the chasm between large and small providers, entities, and practices has been evident.

Obviously, some small groups are well ahead of the pack and some large groups are lagging, but the profound discrepancies keep reappearing. Stanley Nachimson recently commented on the need to do things differently in this additional year. My first thought was, “What things? We need to stay the course.”


My thought now is that maybe we have failed to meet the needs of a significant stakeholder group. Have we really been listening to the issues and concerns or merely citing our solution mantra? At the recent WEDI meeting, we heard yet again from the representatives of the smallest stakeholders that there is no money. It was spent on an electronic medical record that does not meet their needs or function as promised, so now they need a different one. They do not employ and cannot afford coders and the promised ease of a superbill has not materialized. They cannot afford to take more time away from the practice of medicine and their patients. Not only will it compromise patient care, it will decrease cash flow even more. They are drowning in denials now, they can’t survive any more payment disruptions. Patients are struggling with stratospheric deductibles and cannot pay their bills.

The list goes on, but the bottom line is all of the tools (and there are some really good ones), all of the education, all of the promised benefits are falling on deaf ears. Right or wrong, excuse or fact, it is the reality we are facing. If we do not do anything differently, we will likely not see substantial positive change in the responses next year.

Having been an advocate for ICD-10 since 2009 and actively involved in preparation, I was convinced those who would not meet the implementation date were in the minority and that the vast majority of healthcare providers were very supportive of the new code sets. However, the vehement protests to that opinion gave me pause and cause for concern.

So HBMA took a step back and surveyed our segment of the billing and practice management industry to get a big picture snapshot. The preliminary results made that step back seem like a long one down. 

Eighty-five billing and practice management companies responded. Company size ranged from less than 25 employees to companies employing well over 100 employees. Fifty-two percent of the respondents are small billing and practice management companies of fewer than 25 employees.

Those companies represent office- and facility-based physicians, as well as other types of providers in multiple states, and thousands, if not millions, of claims.

Diagnosis coding is performed by professionals and by clients, including software-assisted coding and codes assigned by electronic records. 

Fifty percent use a computer-assisted coding application and 50 percent do not. Sixty percent have been unable to test the ICD-10 automated coding function to date. Of the electronic medical records that assign diagnosis codes, 47 percent do not have ICD-10 coding enabled and tested.

Only a minimal number of companies have been able to conduct full end-to-end testing to date. Of that, 38 percent was deemed unsuccessful.

Forty-one percent were not ready for an October 2014 implementation date.Not surprising were the findings that physician readiness was the biggest impediment (60 percent). Also notable was the lack of end-to-end testing and lack of payor cooperation—both comprised 41 percent of the readiness impediments.

Billing and practice management companies that supported and opposed the delay were evenly divided.

Seventy-four percent of the physician clients supported delaying ICD-10. Only 6 percent opposed the delay, while 20 percent were neutral. 

Although these findings quite obviously do not represent every individual opinion, organization, or group, the billing industry is a key stakeholder with a very broad perspective and provider base. Given the expertise, time, and investment HBMA and the members have made with their readiness and with clients, the big step back may be just what is needed.

To Stanley’s point, we know where we are, but how did we get here, what did not work and why? I think we will know if we listen to every voice, including the ones saying things we do not want to hear, not just those who agree with moving ahead with all possible speed.

How do we work collaboratively to overcome the seemingly insurmountable hurdle many small providers are experiencing? Doing the same thing is not the answer. How do we engage and help the smaller practices, organizations, and companies who do not have the money, resources, time, or personnel to move forward successfully?

Time will not remedy those issues, so is there a realistic solution? Is failure really a viable option? Are stipends or incentive payments possible? If some have fallen and hit bottom, is there a new and better route to the top?

To quote a well-known company: “Less talking, more doing.”

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.
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.

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