Survey: Payers Most Worried About Provider ICD-10 Readiness

The same research that indicates payers are coming right along in their ICD-10 implementation plans also reveals an uncertainty on behalf of payers that the provider community is just as on top of things. Will providers make the Oct. 1, 2013 deadline for ICD-10 conversion? Of the 100 health care payers The TriZetto Group, Inc., in partnership with The Gantry Group, surveyed earlier this year, 86 percent of them said that provider-readiness was their biggest concern.

For more than two years, TriZetto has been following payers’ progression toward 5010 and ICD-10 compliance. In their fifth and most recent survey, “The March Toward Compliance: 2011 Survey Highlights 5010 and ICD-10 Readiness and Continuing Challenges,” payers show a considerable progression toward ICD-10 implementation. This is not to say that concerns do not exist in their own backyard, however.

According to TriZetto, payers are so focused on ICD-10 that they’re overlooking an important first step: 5010 compliance. Will payers be 5010-ready come Jan. 1, 2012? The survey says, of the 100 participating payers:

  • 47 percent have built or mapped 4010 to 5010 files
  • 4 percent plan to neutralize 5010 codes using a step-up, step-down approach
  • 32 percent have tested their 4010 to 5010 maps
  • 9 percent have completed trading-partner on-boarding and testing

The low number of trading-partner testing is concerning. In fact, in another survey released earlier this year—this one done by Health Information and Management Systems Society (HIMSS)—survey respondents (providers) named the following as obstacles to 5010 testing: payers not ready (67 percent); vendors not ready (50 percent); and clearinghouses not ready (47 percent). That same survey showed that 52 percent of provider respondents had a 5010 implementation plan in place in December 2010, up from 38 percent in May 2010.

Once the 5010 compliance hurdle is past us, it’s time to begin the ICD-10 challenge. Payers need not worry about provider-readiness, though. AAPC will be sharing a number of strategies to help practices successfully implement ICD-10-CM. Get started today using your ICD-10 Implementation Tracker on AAPC’s website.

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