ICD-10: Inside the war rooms

Everyone from consultants to hospitals to IT vendors is bracing today for the long-awaited code set conversion
By Tom Sullivan
07:56 AM
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War Room

Within a Washington DC-area consultancy, employees are gathering early in what the agency has demarcated as the war room. 

Some hospitals, meanwhile, have established a command center for triage, while a major consultancy is taking the "virtual command center" approach, and a cloud-based EHR vendor is deploying foot soldiers to practices in several states on both U.S. coasts. 

This is not a matter of national safety and security. Rather, the aforementioned are bracing for ICD-10, the new-to-us 20-year old classification system that U.S. healthcare payers and providers must start using as of October 1, 2015.

A fine fuss
ICD-10 has been debated, delayed, and threatened more times than most people would care to even count. America's need to upgrade our coding system has also been defended and now it's actually here – but all the years of prolonged confusion have made something of a mess. And up until the end readiness surveys demonstrated an industry not nearly as prepared as perhaps it should be for the compliance deadline.

The Centers for Medicare and Medicaid Services this summer extended an olive branch of sorts when it conceded to American Medical Association suggestions, including that it will not deny claims filed in ICD-10 for the first year so long as they meet certain criteria, notably being in the proper family of codes. 

[Innovation Pulse: PIck your own ICD-10 adventure.] 

By most accounts the move was akin to CMS offering a grace period – and it will smooth the transition by granting providers of all sizes 12 months to learn the codes most applicable to them. 

What's happening today?
This is it: Any claims filed as of September 30 had to be submitted in ICD-9; now it's ICD-10 only for the foreseeable future.

"I believe we are well prepared and cautiously optimistic for the ICD-10 cutover. All core and downstream systems have been tested. Test claims have been submitted to our payers and reviewed for proper formatting. Our Health Information Management coding team has been expanded and enterprise awareness and education is in place," Penn Medicine CIO Michael Restuccia explained. "With that said, we will have a centralized Command Center in place for an estimated two-week timeframe that will be staffed by IS and operational support resources along with representation in the ambulatory clinics in order to provide shoulder-to- shoulder support when needed." 

Taking a similar approach, Rochester Regional Health System established a command center taxed with triage – IT staffers will be on hand to direct issues to appropriate experts as they arise.

These are not last-ditch efforts, either. 

"Dual coding was started and continues, KPI baseline measures were established and metrics developed for future monitoring," Diana Adam-Podgornik, Rochester Regional's coding compliance coordinator told Healthcare IT News for a previous article.

Expect the best, prepare for problems
Whereas many ICD-10 experts are predicting that hospitals and health systems such as Penn Medicine and Rochester Regional will fare reasonably well during the code set conversion – not without some problems but sans catastrophe – it's the smaller medical practices that are most disconcerting.

EHR maker Practice Fusion intends to visit customers in Jacksonville, San Francisco, San Jose and New York City "to ensure that we are helping to create an environment where changes for ICD-10 don't take long to implement," according to a spokeswoman. 

In the less-covered property and casualty insurance market Mitchell International has been crafting databases specific to ICD-10 for more than four years.

"Our plan has been that after the conversion, several of these resources will be used for increased calls to support our customers as they use ICD-10. We have built capacity to handle direct support amongst the same team that works with and performs compliance maintenance in our software products," said Michele Hibbert-Iacobacci, vice president of information management support at Mitchell. "In addition, we have staged Internal FAQs, created scenarios in ICD-10 for the most frequent case mix types in P&C and have tested the products extensively over a 2 year period of time."

Rounding out the broad swath of payers and providers preparing for ICD-10, Accenture is also saying is feels prepared

"We set up a virtual command center where we have point people identified and a clear escalation pathway for rapid response to ICD-10 issues, in case needed," said Kaveh Safavi, MD, global managing director of Accenture's health business.

Safavi, like nearly everyone Healthcare IT News contacted for this article, is expecting the first few days in October to be relatively quiet, at least ICD-10-wise.  

"We'll be in our 'War Room' in National Harbor, MD, ensuring we are able to tackle any of the issues that our doctors may have," said Vipul Shah, a vice president for consultancy Health Prime International, which has a 550-person team trained on ICD-10. "This will be a test for them and for us." 

Related articles: 

The case for creating an ICD-10 command center

ICD-10 readiness in a state of 'shaky optimism'

Industry eyes calendar with ICD-10 countdown underway 

AMA's long war of words against ICD-10