CMS-10381 Appendix D2 ICD 10 readiness assessment questionnaire fo

September 26, 2012

ICD-10 Industry Readiness Assessment

[Intended for fielding after the ICD-10 compliance deadline]

Background

The questions that follow are designed to gauge the health care industry’s progress in making the transition to ICD-10. The survey is being conducted for the Centers for Medicare & Medicaid Services (CMS) and should not take longer than 10 minutes. Your participation is voluntary and your responses are confidential; only de-identified, aggregated data will be provided to CMS. This information will be used to inform outreach and education efforts to help health care providers, payers, software vendors and clearinghouses prepare for the coming transitions.

Please select the term below that best describes your organization [Please select one response]:

1. Provider practice, small (10 or fewer physicians )

2. Provider practice, large (11 or more physicians)

3. Hospital, small (99 or fewer beds)

4. Hospital, large (100 or more beds)

5. Payer (private)

6. Payer (public, e.g., Medicaid, TRICARE)

7. Other insurer (e.g., property and casualty)

8. Software vendor

9. Clearinghouse

10. Third-party biller

11. Third -party administrator

12. Other (specify)

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection will be entered after clearance. The time required to complete this information collection is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, Office of E-Health Standards and Services (OESS), Administrative Simplification Group, Attention: OMB Approval Number, Room C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 21244-1850

[IF Q1=1-7, 9-11] Which of the following statements best describes your responsibility in your organization’s ICD-10 transition? [Please select one response.]

• I am the most senior person responsible for the company’s transition

• I am not the most senior person, but am involved in the transition and I have significant input or influence into the decisions regarding the systems and/or procedures

• I make recommendations regarding the systems and procedures, but am not a decision-maker [TERMINATE]

• I provide support (and work with the systems used) for reporting patient information for billing and reimbursement, but have no influence over what procedures or systems are implemented [TERMINATE]

• None of the above [TERMINATE]

[IF Q1=8] Which of the following statements best describes your role when it comes to marketing the systems/solutions/services you offer or will offer your health care clients to assist them in the transition to ICD-10? [Please select one response.]

• I am the most senior person in the company responsible for marketing these systems/solutions/services

• I am not the most senior person, but I have significant input or influence into the decisions regarding marketing these systems/solutions/services

• I make recommendations regarding marketing these systems/solutions/services, but the final marketing decisions are made by someone else [TERMINATE]

• I will implement the marketing or sell these systems/solutions/services, but have no influence over marketing decisions [TERMINATE]

• None of the above [TERMINATE]

About the ICD-10 Transition on October 1, 2014

ICD-10 codes must be used on all HIPAA transactions, including outpatient claims with dates of service and inpatient claims with dates of discharge on and after October 1, 2014.

This change does not affect CPT coding for outpatient procedures.

Directions:

Please read About the ICD-10 Transition above before answering the following questions.

Was your organization ICD-10 compliant by the October 1, 2014, deadline?

• Yes [Terminate survey]

• No

• Not sure

Has your organization taken action to prepare for the ICD-10 transition?

• Yes

• No

• Not sure

What obstacles and challenges has your organization encountered in the effort to transition to ICD-10? [Please select all that apply]

• Impact analysis not conducted

• Inadequate budget/funding

• Lack of incentive

• Lack of time and/or staff

• Internal testing not complete

• External testing not complete

• Lack of coordination with vendor(s)

• Other health care transition(s) taking priority (i.e., Meaningful Use)

• Running dual systems to accommodate ICD-9 and ICD-10 codes simultaneously

• Other [please specify]

[Please indicate when you completed or plan to complete the following activities to prepare for the ICD-10 transition.]¹

Activity	Completed before Nov 2014	Nov 2014	Dec 2014	Jan 2015	Feb 2015	Mar 2015	Apr 2015 or later	Not planning for this activity	Don’t know
Conduct impact analysis (e.g., identify everywhere you use ICD codes for potential changes to work flow)
Develop ICD-10 implementation plan
Talk with your business trading partners (providers, payers, vendors) about transition plans
Secure budget (time and costs related to implementation)
Begin internal testing (e.g., test changes in software, practice within your organization)
Complete internal testing
Begin external testing (e.g., between providers, payers, billing services, clearinghouses)
Complete external testing (i.e., complete testing of processes from beginning to end, including claims and other inbound and outbound transactions)
Conduct staff training
SOFTWARE/HEALTH IT DEVELOPERS/VENDORS
System development
Product rollout
Conduct customer education
Live production operations using ICD-10

1 To minimize burden to respondents, CMS requests permission to delete timeframes from this table as they become outdated (e.g., if the survey is fielded in December 2014, CMS would like to delete the “Nov 2014” response option and replace the “Completed before Nov 2014” response option with “Completed before Dec 2014”).

4