July 16, 2013

ICD-10: Haven’t Started? Need an Excuse? Here it is!

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EDITOR’S NOTE: The following is a transcription of a recent segment by Denny Flint on Talk-Ten-Tuesday.

From audience after audience, in survey after survey, we keep hearing that 40-50 percent of physician offices haven’t even started ICD-10 implementation efforts yet.

Out of the WEDI meetings, we heard that payers may be ready, but many providers will not. On Talk-Ten-Tuesday we hear experts like UnitedHealth Group’s Annie Boynton talk about more fears that providers won’t be ready to go. We see a Centers for Medicare & Medicaid Services (CMS) timeline recommending that internal testing begin on April 1 of this year, and yet in dozens of physician and staff ICD-10 workshops during the last few months, not one hand is raised when I ask if internal testing has begun.

What’s it going to take to get those practices off the ground? Well, if you’re looking for an excuse to finally start getting serious about the ICD-10 transition, here it is. A few weeks ago I mentioned I was out on the Tennessee Medical Association’s Road Show with Aaron Sapp from UnitedHealth and Scott Hightower from Blue Cross. We talked a lot about testing, meaning full-cycle, end-to-end simulated claims submission from initial connectivity and claim submittal all the way through remittance advice, denials and refund requests.

While United and Blue Cross had differing ideas about how to manage the process, we agreed that end-to-end testing is really the only way to ensure that your practice’s claims submittal processes are ready to go for ICD-10. United may be testing by specialty; Blue Cross may be testing in phases. But both are testing. We also heard at HIMSS recently that CMS is indicating that it never had any intention of conducting external end-to-end testing.

But here’s what you need to know if you’re looking for an excuse to stop talking about ICD-10 and start doing something about it. Both Sapp and Hightower admitted (listen carefully, here it comes) that the payors do not have the bandwidth to accommodate every practice for testing. Testing will be a massive undertaking, and the payors will have a difficult time conducting day-to-day business if they try to test with every single practice. Therefore, we may be faced with a first-come, first-serve scenario whereby only those practices that get in line early enough to test may actually be able to do so.

To me, this is the single most important milestone in the entire ICD-10 transition. If you can’t test, you can’t know whether your system is ready to go. And you must get far enough down the implementation path in order to be able to test effectively. If you are looking for a reason to get serious about ICD-10, this is it! And don’t forget, testing can resemble a four- or five-legged stool, depending on whether or not you use an outside billing agency. Not only must the practice be ready to test, but so must its software vendor, clearinghouse, and obviously the payer. This takes time to coordinate and time to prepare. It’s not just, “When are we going to test?” It’s also, “What are we going to test? How are we going to test? Who will coordinate the testing?”

Being assured of being able to get in line to test is the excuse you’ve been looking for if you still haven’t started your ICD-10 implementation efforts. If you wait too long to get in the testing queue and the payer ultimately says, “I’m sorry, we’ve reached maximum capacity and you will be unable to test,” what will this mean to you? Have you ever gone on a really bad blind date? That’s what Oct. 1, 2014 will seem like. You might be filled with anticipation and full of hope, thinking you’re in for a really fun time, but when the door opens you can’t take your eyes off the prison tattoos, the army of cats in the living room, and … what the heck is that horrible smell?

Oct. 1, 2014 will be precisely like that if you fail to test and find out too late that your system is unable to go.

And faking appendicitis to get out of that blind date will not be an option.

About the Author

Denny is the chief executive officer for Complete Practice Resources, a healthcare education, consulting, and software company headquartered in Slidell, Louisiana. He formerly served as the CEO of a large, multi-specialty physician group, full service MSO. Denny has authored or co-authored numerous “common sense” practice management books and implementation manuals. He is an award winning, nationally known consultant, speaker, and educator bringing his expertise to making the complex “simple.” He currently serves on the editorial board of ICD10monitor. Educated at the United States Air Force Academy, Denny had a distinguished career as an Air Force pilot and has a long history of commitment to excellence and dedication to his clients’ success.

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Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Denny Flint

Denny is the chief executive officer of Complete Practice Resources, a healthcare education, consulting, and software company headquartered in Slidell, Louisiana. He formerly served as the CEO of a large, multi-specialty physician group, full service MSO. Denny has authored or co-authored numerous “common sense” practice management books and implementation manuals. He is an award winning, nationally known consultant, speaker, and educator bringing his expertise to making the complex “simple.” He currently serves on the editorial board of ICD10 Monitor. Educated at the United States Air Force Academy, Denny had a distinguished career as an Air Force pilot and has a long history of commitment to excellence and dedication to his clients’ success.