Progress toward ICD-10 implementation is revving up, according to a survey commissioned by the TriZetto Group, a provider of healthcare IT software and service solutions.
The survey, "The March Toward Compliance: 2011 Survey Highlights 5010 and ICD-10 Progress and Continuing Challenges," tracks payers' progress in migrating to HIPAA 5010 and ICD-10 compliance. Conducted by the Gantry Group, the survey is part of an ongoing study of 100 healthcare payers in the United States.
According to the survey, 93 percent of healthcare payers have chosen an approach for their core administration ICD-10 migration efforts, up from 75 percent in the third quarter of 2009.
[See related stories: CMS to survey HIPAA 5010, ICD-10 preparation; concern persists for HIPAA 5010, ICD-10 non-compliance fines]
"The vast majority of the country's health plans have committed to the technical updates of the 5010 and ICD-10 mandates, signaling significant progress," said Greg Larson, associate vice president of services product management at TriZetto.
"Decisions on mapping strategies, updates to systems including core administration and care management, and plans to update some business workflows all point to great progress," he said. "Watch for some health plans to go beyond technical upgrades to reconfigure benefits plans and care programs, as well as provider contracts."
According to the survey, 46 percent of payers plan to model the impact of ICD-10 on provider contracts and 33 percent are developing new payment models. Larson pointed out that modeling can help ensure that a plan's claim payments in ICD-10 are the same as they would have been in ICD-9, thus achieving financial neutrality. He also said modeling the impact of ICD-10 positions health plans to renegotiate their contracts with providers.
In addition, Larson noted that the 32 percent of payers that are reconfiguring benefit plans and workflows and are taking significant steps to improve their automated claims-payment rates, a key metric of administrative efficiency.
Larson said the survey found a "new and troubling" concern about provider readiness for ICD-10. The survey reported that 86 percent of health plans are most concerned that providers will be unprepared for ICD-10 compliance and technically unable to submit claims using ICD-10 codes.
"In the third quarter of 2009, health plans were concerned primarily about vendor readiness," he said. "Now, payers are most concerned that providers will be unprepared to submit claims with the new code set. Just as worrisome is that only 9 percent of health plans have begun to on-board and test provider data for this capability. Slow provider uptake could delay the deployment of new healthcare reform initiatives such as accountable care organizations, patient-centered medical home and other emerging models that could improve both the cost and quality of healthcare in America."
With regard to HIPAA 5010 compliance, a prerequisite for successful ICD-10 migration, Larson expressed encouragement that with less than eight months to the deadline, nearly half of payer organizations (47 percent) have built or mapped HIPAA 4010 to HIPAA 5010 files, although just 9 percent have completed 5010 trading partner on-boarding and testing.
Additional key findings from the survey include:
- Health plans are markedly more receptive to vendors' assistance in meeting the October 2013 deadline for ICD-10 compliance. Compared to the third quarter of 2009, more payers are amenable to assistance with IT infrastructure modifications (57 percent, up from 47 percent), strategic planning (50 percent, up from 41 percent), care-management upgrades (49 percent, up from 22 percent, and testing (49 percent, up from 39 percent).
- Payers increasingly are moving toward upgrading core systems (65 percent), rather than buying new (14 percent).
- Nearly six in 10 payers have chosen a single, enterprise-wide ICD-9 to ICD-10 mapping/translation strategy.