Updated on: March 16, 2016

Lack of Provider Readiness is “Disturbing,” says One Payer

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Original story posted on: January 31, 2013

“The game is afoot!”—or at least that’s what Sherlock Holmes uttered to Watson before one of their criminal-catching adventures, and it’s also true in the case of ICD-10 preparation.

Although the Oct. 1, 2014, implementation date is still 21 months away, guests on the Jan. 29, 2013, broadcast of Talk Ten Tuesday proved that preparation is, indeed, afoot.

 

Producers of the broadcast pulled together spokespersons from a cross section of the healthcare industry. Specifically, the broadcast featured…

  • Annie Boynton, director of 5010/ICD-10 communication, adoption and training for UnitedHealth Group;
  • Brooke Palkie, assistant professor from the College of Saint Scholastica
  • Kim Harrison, corporate HIM operations coordinator, and Kyle McElroy, director of HIM operations, both from IASIS Healthcare
  • Kathleen Frawley, the president and chair of the American Health Information Association (AHIMA).

As always, the broadcast also included the weekly Ten Ready Poll. Previous poll results showed that, in relation to adopting a clinical documentation improvement (CDI) program, listeners’ biggest concerns related to physician cooperation. To take the topic one step further, the January 29 broadcast included the following poll question: What tools and processes are you using to educate your physicians?

The answer to that question was quite telling in that 46 percent of the listeners who answered the poll question replied that they “don’t know yet.” Clearly, not a good sign since many experts believe that 2013 is the year to get physicians on board and launch CDI programs.

Another 26 percent intend to “perform ICD-10 documentation audits,” 13 percent plan to “perform concurrent I-9/I-10 audits via data,” and the final 5 percent will “perform concurrent I-9/I-10 audits via computer assisted coding (CAC).”

Getting the Message Across

 

Although most in the industry are concerned about physician readiness, others wonder whether payers will be ready. Boynton provided good news to United Healthcare’s providers, stating that the company has been working on the ICD-10 transition since 2009, and it anticipates being fully ready by Oct. 1, 2014. Boynton also says that the “majority of payers are confident that they will meet the deadline.”

At the present time, United Healthcare’s focus is testing its systems and increasing communication with, and education of, the provider network. “Unfortunately,” Boynton says that she is seeing a “lack of readiness”—a situation that is “disturbing.”

Apparently, “Many providers don’t understand why I-10 testing must occur between providers and payers and why it’s so important,” she says. Part of the company’s training programs now being developed will address this issue.

“We want enough time for a robust testing program,” Boynton explains. “We’re going to dive into the heart of what testing means to physician practices, for example.”

AHIMA Provides Educational Foundation

 

As we might expect, AHIMA is doing what it can to meet the challenge of ensuring that coding professionals have the resources needed to prepare themselves for both ICD-10-CM and ICD-10-PCS. To find the tools needed, Frawley directed listeners to the Resources tab at www.ahima.org, explaining that managers and coders will find, among other items, links to coder workshop training (hands-on and in-class exposure), AHIMA-approved trainers, and the ICD-10-CM/PCS Leadership Model.

She also called attention to AHIMA’s upcoming ICD-10-CM/PCS and CAC Summit, which will be held April 22–24. The goal is to bring together coding professionals, HIM managers, payers, and others to discuss the best implementation strategies–those that will guide organizations to a successful transition from ICD-9-CM to ICD-10-CM/PCS.

As a matter of fact, Palkie indicated that HIM professionals at the College of Saint Scholastica are using AHIMA’s recommendations to teach students.

 


 

Palkie says that the school’s training program allows students to get a feel for the whole process and experience its trials and tribulations. “It’s a tremendous opportunity to advance the skill sets of coders,” she says. “They are learning that the specificity required by ICD-10 affects everything in the process--documentation, coder queries, claims processing, payer relations, compliance, risk management programs, etc.”

In addition to training new students, the College will be offering opportunities for the community to refresh their skills or develop new certification.

Proactive Planning

 

IASIS Healthcare, a large system in Franklin, Tennessee, is also moving right along with its implementation plan with a principle focus on getting its health information system ready for integrated testing. This certainly is understandable since the healthcare system owns and operates 19 acute care hospitals throughout the country with more than 14,000 licensed beds.

IASIS is also ahead of the pack when it comes to coder training, which is ongoing. McElroy reports that HIM staff completed anatomy and physiology (A&P) training about a year ago, and now coders spend 30 to 60 minutes per day “practicing on either outpatient or inpatient surgical accounts to get comfortable with the new codes.”

As Harrison explains, “We want to focus on real-world cases, especially I-10 PCS. We know coders will struggle with these, and we plan to have focused education there.”

Not surprisingly, what would really help coders is for providers to submit documentation in a timely manner, said McElroy. Harrison agrees, saying that this is the HIM department’s biggest challenge. A special training program will be developed for physicians and other non-coding staff, such as nurses who perform front-end order-entry.

With these experiences under his belt, McElroy does have some advice for others embarking on training. “Realize that you won’t master it all at once. Any hospital will be challenged with what has to be coded today and shifting a coders’ mindset to I-10 assignments.”

And the clock keeps ticking.

 

EDITOR’S NOTE:

Kari Gaare from the CMS and Dean Cook from the National Government Services will be featured guests during the Feb. 12 edition of Talk-Ten-Tuesday.

Talk Ten Tuesday Jan. 29, 2013

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.
Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for RACMonitor.com and ICD10Monitor.com; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.