Updated on: September 23, 2013

Query Your Payers, Vendors About Testing

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Original story posted on: May 24, 2013

Greetings, fellow ICD-10 travelers.

This is your old pal Denny here in Week 3 of an eight-week road tour. Last week was marked by a journey to the Tennessee Medical Association’s annual Road Show, and it was a doozy. Every venue was sold out, which tells me that ICD-10 urgency finally has arrived. I’ve been conducting live healthcare practice management lectures for almost 25 years, and during my visit I had my first “I’ve never done this before” experience in a long time (unless you want to count that one time in college … uh, never mind). No, the first-time experience I’m talking about concerned my co-presenters for the Road Show. I actually co-presented with representatives from Blue Cross and United Health Care. I know, right? Can you imagine Denny Flint on the same stage as representatives from the payer community?

When I arrived I expected to get frisked and warned what I could and could not say by those guys from The Matrix in the dark suits and sunglasses. When I first met my fellow presenters, I carefully checked for horns and forked tails, or any signs of mind control or an evil agenda. Imagine my surprise when (gulp) I actually thoroughly enjoyed meeting these fine folks. Don’t worry, though: I didn’t sell out. Hard questions were asked, and here’s a snapshot of how the week went.

Aaron Sapp is the national ICD-10 program director for United Health Care. His role is to explain how the company is handling ICD-10 and to act as a conduit to the payer perspective for providers. When I asked him how the audiences were treating him, he said, “sometimes, I feel like a diaper.” That’s funny, right? He wears bow ties because he says nobody wants to beat up Orville Redenbacher. His presentation was engaging, to the point, and full of excellent content, and it highlighted all the resources United Health Care is offering to you, the “delivery” side of the healthcare cycle. This includes town halls, news bulletins and online education offerings, just to name a few.

Scott Hightower is the director of provider service for Blue Cross of Tennessee. He reiterated the importance of providers giving Blue Cross what it needs to pay claims. He had these really cool devices that allowed him to poll the audience in real time for answers to questions such as “Is your organization’s enterprise-wide ICD-10 project on target?” It came as no surprise when the majority said that either their projects were behind schedule and may not be completed by the compliance date, or that their project plans were in place but there still were areas of potential delays and concerns. Scott talked about Blue Cross’s financial code mapping and the complexity ICD-10 creates in multiple diagnostic scenarios. And no, we asked, they will not share their mapping, because that proprietary information is what separates their offerings from those of other payers. I’m not sure how to take that answer. He also spoke about testing initiatives and what a massive undertaking it is to develop testing protocols.

The one negative I have to report is the lack of consensus about what testing actually will look like, and how it is proposed to make it happen. Many think that testing most likely will roll out in phases, with the first being connectivity, possibly followed by testing by specialty. Some professed that, except for testing, they are by and large on target for implementation.

Folks, the most important word in the English language when querying your payers about testing (or any of your vendors, for that matter) is this: “when?” “When can you give us the testing plan? When can we begin? When can we test specific scenarios? When can we expect full cycle testing, including not only the ability to submit claims, but also the testing of eligibility, pre-authorization, refund requests, and remittance advices?” If they answer, “we don’t know,” ask, “well, when will you know? Because we’ll be calling again.”

All in all, these payer folks are just people, and I like them. They really do care about your success, because if the system collapses due to lack of readiness, this affects them as well. They want you to be prepared, for that reason.

So I have one question: If you haven’t started your transition yet, when will you?

About the Author

Denny is the president 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.

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All ICD-10 Test Data Is Not the Same

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.