A payer's advice on ICD-10

By Tom Sullivan
10:08 AM
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Even against the backdrop of HHS saying it intends to push back ICD-10 compliance, there’s no shortage of healthcare entities insisting they will march forward with their conversion plans, aiming to be ready by October 1, 2013 – federally-mandated deadline, or not.

Indeed, the delay “requires us to re-double our resources,” said Joe Miller, director of e-health at AmeriHealth Mercy Family Companies during a panel discussion at HIMSS12, adding that HHS announcement “creates a challenge because the leadership in our organizations might re-direct resources to other things.”

[See also: If HHS delays ICD-10 long enough, could the U.S. adopt ICD-11 instead?]

Regardless of the ultimate deadline, healthcare entities will have to comply at some point. The upside to a new date, however, is that payers and providers might have a little breathing room, with which Sidney Hebert, executive program manager in charge of ICD-10 at Humama recommended using to formulate testing requirements, evaluate the test scope, consolidate that down to 200 or 300 actual tests to run, and plot a risk-based approach.

“If anyone thinks this is just about coding,” Hebert cautioned, “you better take another look at your technology.”

Hebert did just that and found 70 major applications at Humana that ICD-10 will impact. Humana is by no means an outlier in that regard, either. AmeriHealth Mercy’s Miller added that according to a HIMSS survey 30 percent of healthcare organizations have more than 50 vendors. During the 30 years that ICD-9 lingered, the outgoing classification system has permeated many, many systems. “Every major area of our business that’s meaningful is going to be updated,” Hebert said.

Which is why Hebert urges payers to garner broad support within corporate leadership, identify subject matter experts to pull into the ICD-10 project, develop testing strategies for every element, consider tools and services for tracking testing, and pinpoint the highest-impact areas to prioritize them. “Testing is not a defensive posture, it’s an offensive posture,” he added.

Particular to the revenue cycle, ICD-10 can bring quicker turn-around times, fewer denials. Payers will also benefit from more accurate claims, and improved data collection and analysis, Baskar Mohan, director of IT consulting and outsourcing vendor Virtusa wrote in Government Health IT.

Mohan added that ICD-10 is intended to help payers save millions of dollars every year by reducing improper coding and payments that, under ICD-9, can sometimes be caused by insufficient data.

[Related: AHIMA says its time to think training -- and keeping -- your coders.]

“Everybody’s going to benefit,” Humana’s Hebert said. “But we have to get over that [initial] loss of productivity.” Rather than aiming for financial-neutrality as is often discussed with the ICD-10 migration, Humana views ICD-10 as an opportunity to bolster consistency and traceability within its revenue cycle.

Hebert also warned that staffing will likely be a problematic issue. “Everybody in our company has a full-time job – and it’s not ICD-10, other than a small team,” he said. “So recognize there’s going to be a productivity hit as these people work on ICD-10.”

Tom Pacek, CIO of South Jersey Healthcare said that the mere mention of HHS pushing back ICD-10 compliance has already caused him staffing headaches, as the human resources department has started pushing back on hiring to replace coders who recently left their jobs.