June 4, 2013

Providers: How to Win the ICD-10 Testing Challenge

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Providers are scrambling to meet the ICD-10 compliance date of Oct. 1, 2014 as the healthcare industry moves forward at a faster pace in its preparations. Many providers across the continuum of care are struggling to meet all the many regulatory challenges simultaneously.

The major payers are in the process of building ICD-10 end-to-end testing strategies and roadmaps; we hear that payors are not planning to test with all providers. ICD-10 testing is the single most complicated preparatory milestone in the transition to ICD-10. The industry has a responsibility to healthcare consumers to transition to ICD-10 successfully, with no disruption to the business of medicine. Can we meet the compliance deadline and mitigate the risks to providers and consumers alike? The answer is: We must! So how do we get the late-adopting providers who are facing financial risk, and in many cases, depleted resources, on board?

Providers within small practices and ancillary service providers have expressed concern about how to gauge the impact of the coding translation, which has to be done within clearinghouse software applications and/or the practice management applications and EMR without sending test claims through to the payers. There is significant concern that there could be a delay that could impact AR, which presents a more immediate problem for small medical practices. Understandably, payers only are able to test with high-volume providers as well as critical or key providers within their networks. So, who does a small, one- or two-physician practice or ancillary provider test with to help them understand the ICD-10 transition process and financial impacts?

While conducting informal research with several physician organizations to get an idea of what guidance they are providing to their members, it became obvious that a significant volume of communication about ICD-10 came in the form of press releases and industry comments when the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) announced the one-year delay, thus making the compliance date fall in October 2014.

I struggled to locate any meaningful ICD-10 information or resource library information visible on membership portals. I tried multiple search approaches, too, to make sure that I was not missing where this information might be stored; the majority of the sites were silent on the critical need for improved clinical documentation or the importance of ICD-10 testing and the potential impact on cash flow.

The American Academy of Family Physicians, the American Academy of Orthopedic Surgeons and the American Academy of Obstetrics all have little current information about ICD-10, and these sites are just a sampling of those that are lacking in such a manner. In comparison, the American Academy of Internal Medicine clearly has assumed a very proactive approach to communication, providing ongoing Webinar sessions addressing the issues of CDI and testing, including the potential “impact of cash flow to a practice.” The looming question is this: What role can these organizations play as we move closer to the implementation date? We know that there is a common message in the mission statements of the various medical specialty organizations; for example, the American College of Physicians (ACP) mission is “to enhance the quality and effectiveness of healthcare by fostering excellence and professionalism in the practice of medicine.”

One would assume that since ICD-10 will have a huge impact on the business of medicine, professional organizations would assume a very active role in assisting their memberships achieve compliance by providing testing and CDI seminars customized by specialty. Professional organizations dedicated to individual medical specialties play an important role in disseminating best clinical practices and offering data input for clinical research, which generally has not been so visible on the ICD-10 radar screen or included in many surveys. Driving memberships toward improved clinical documentation from specialty professional organizations and the alignment of code translation within each specialty to increase the value of research has become a focus of global health initiatives.

Professional organizations can play a critical role in moving providers further along their ICD-10 transition roadmaps by expanding their understanding of ICD-10. This should involve clarifying that ICD-10 will have little impact on the practice of medicine, but a huge impact on the business of medicine. The most vital forms of currency for providers include time, and medical professional organizations can play a critical role in time management and offer value to providers by reaching their memberships via websites to push out CDI/ICD-10 training materials customized by medical specialty. Professional specialty organizations can customize testing relative to any particular medical specialty for which ICD-10 is expected to bring major changes, bringing meaningful and incredible value.

Is it time for providers to look within their circles of influence by reaching out to their professional organizations to set up testing models and testing “sandboxes” to provide simulated test processes – and to provide a member support call and/or Web service to provide relevant ICD -10 information to assist inICD-10 implementation.

Physicians and ancillary providers can translate the industry “buzz” revolving around ICD-10 end-to-end testing into an actionable plan with post-compliance support, and the medical specialty professional organizations, critical players in the industry, can work with providers to achieve success. In this way providers can put out a “call to action” and have the medical provider organizations assume a very important role in achieving ICD-10 compliance.

About the Author

Ellen VanBuskirk, senior principal in business consulting for Infosys Public Services, is a healthcare consultant focused on compliance strategies with a mission to work across the Healthcare value stream to meet regulatory challenges. VanBuskirk has conducted business development efforts in support of healthcare compliance and reform, as well as ICD-10 transformation by both provider & payer organizations. With more than 20 years of success in leading business teams and identifying emerging opportunities and challenges in the healthcare industry, VanBuskirk brings deep expertise in health plan regulatory and compliance initiatives, including healthcare reform, ICD-10 transformation, meaningful use, HITECH and HIE.

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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.
Ellen VanBuskirk

Ellen VanBuskirk is the national director of healthcare practice with Slalom Consulting and has held executive positions in provider, payer, and managed care organizations. She started her career in clinical delivery with an expertise in emergency medicine. Ellen brings her expertise of working for many years on the U.K. National Health Service Modernization Program, as well as her experience of working on global and domestic healthcare program change for her clients.