Most healthcare organizations have modified or customized their billing applications to meet their own unique needs in regard to payer mix, clinical programs, or provider-based billing arrangements. While these customizations are fine for their intended purposes, they nonetheless pose rather large obstacles to the ICD-10 code conversion process.
There is still a misconception among many organizations that vendors are chiefly responsible for ICD-10 preparation. In truth, vendors are only one piece of the puzzle. While they indeed must alter products to accommodate ICD-10, they typically are not liable for any of your in-house customizations. Furthermore -- and perhaps needless to say -- vendors are not the ones who will suffer claims rejections starting Oct. 1, 2013, should your organization not meet the ICD-10 implementation deadline successfully.
To mitigate cash flow risk throughout the ICD-10 transition, organizations must be able to identify any customized data fields that either directly or indirectly relate to diagnosis codes. Customizations frequently appear in applications such as dictionaries, charge entry screens, code scrubbing logic, claim form logic, and reports. But these applications often are only the beginning.
For better or for worse, tracking the location of diagnosis data fields within customized applications depends as much on relationships as on spreadsheets. The very first step, in fact, is to ramp up internal communications where necessary to make sure your IT shop is in tune with your billing shop. IT staff must understand existing revenue process and flow; billing staff are pivotal for accurately identifying areas of ICD-9/ICD-10 contact.
Billing staff are in the best position, for instance, to identify those payers with the largest impact on the revenue stream. Your IT staff will need to assess and test electronic data interchange (EDI) transactions with these payers before those with smaller revenue footprints. Often -- especially in situations when the billing and IT staffs operate in relative isolation -- it's helpful to establish the ICD-10 project management team as a liaison.
Once the political groundwork is smooth, you can begin looking for actual applications that involve diagnosis codes. Obviously, highest priority goes to those systems that most closely affect patient health and safety. Interface engines should be the next area of focus, followed by billing systems.
In each case, walk through the entire data cycle. Start from the moment a patient encounter is scheduled and a presenting diagnosis is documented. Map all incoming and outgoing diagnosis-related data fields, and determine whether each piece of data is supplied in-house or by a vendor. In other words, the project management team must identify whether each data field is:
• Incoming or outgoing; and
• Vendor-sourced or internally-sourced.