October 28, 2013

The Deadline No One is Talking About

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Greetings, everyone.

In this article, first I want to address some “show” business; then I want to talk about the deadline no one seems to know about. Since the AAPC National convention in May, I’ve been to national trade show after show.

Most recently it was the Medical Group Management Association (MGMA) conference in San Diego and the American Association of Healthcare Administrative Management (AAHAM) conference in New Orleans. The shows provide excellent opportunities to learn about ICD-10, but I’ve come to realize that you have to be really careful about believing everything you see and hear.

 

Between my own speaking engagements at these conferences, I try to attend as many other talks on ICD-10 that I can. Frankly, some of these speakers are not as informed as they should be, so I ask that you don’t take everything at face value and be sure to fact-check the information you hear.

For example, in New Orleans I sat through one talk about conducting ICD-10 testing with payers. The speaker was adamant that payers would be conducting full cycle testing with each and every provider – which we know is not the case. Due to the massive undertaking of the revenue mapping between ICD-10 and CPT® codes, the payers will be unable to test except with a few (what they call “selected providers.”) Many have said they will be relying heavily upon the HIMSS ICD-10 Task Force pilot program test data, which, as Rhonda Taller mentioned in her “Talk-Ten-Tuesday” segment on Tuesday, should be released later in the fall. By the way, I strongly urge you to get a copy of that study for a heads-up on payer ICD-10 strategy concerning key scenarios – to that end, I look forward to Stanley Nachimson and Rhonda’s updates on future “Talk-Ten-Tuesday” broadcasts.

Another thing I like to do at these shows is to visit as many electronic health record (EHR) vendors as I can and ask them about their ICD-10 readiness. After conducting more than 50 real-world ICD-10 readiness assessments and implementations, one of our biggest challenges as consultants was getting straight answers from vendors.

When asking about ICD-10 deployment so our clients can start training, dual coding, and internally testing, I am constantly frustrated by vendors who provide the smokescreen answer of “We’ll be ready. Tell your clients not to worry.” Those are not the answers you’re looking for to the questions you need to ask. Walking around a giant trade show floor like at MGMA, even this late in the game, it is painfully apparent that with very few exceptions, vendors – your most important external stakeholders in the entire transition – are not ready.

I urge you to contact them and ask the hard questions. When will ICD-10 be deployed in our organization? Will there be downtime as a result of the deployment? Will we lose current customization? What will dual track coding look like? (We’ll need to continue to work ICD-9 claims well after the transition date, and HIPAA-exempt payers like workers’ compensation, auto ins, and disability don’t have to spring for ICD-10 at all – and many have already announced that they will not.) Who is paying for the upgrade? (Even if they don’t charge for the actual insertion of the code set, find out whether or not there will be charges for template redesign, training, maintenance and support.)

And what about testing? (Now that we know you most likely will not be able to test with the payers and are being urged to coordinate testing with the clearinghouses instead, what’s that going to look like, and who will be scheduling – you or the vendor?

I asked these questions of vendors at the shows and again, with few exceptions, clear-cut answers were not forthcoming.

As mentioned, I also want to touch on the deadline no one seems to know about. I attended a payer panel a few weeks ago where we heard a lot about ICD-10 readiness. Just like the news we’re hearing out of the Workgroup for Electronic Data Interchange (WEDI), the message was that payers will be ready even though they won’t be testing externally with everyone. The one pleasant surprise we heard was that the payers will start accepting ICD-10 claims for pre-authorization on June 1, 2014 for services and surgeries leading up to the Oct. 1, 2014 mandate.

We’re still seeing polls and surveys indicating that providers are way behind. If you needed the impetus to start your ICD-10 implementation, this is it. You have to be far enough down the transition road to be able to submit ICD-10 claims for preauthorization on June 1 if you expect to perform pre-authorized services or surgeries on or after Oct. 1. That’s only seven months away. We are no longer talking about the deadline in terms of “years away.” 

So get cracking!

It’s an arduous journey that has to start with that first step – but you gotta take that first step. Even the construction project for the Great Wall of China, something that reportedly can be seen from space, was started with that first brick. It’s just a project. You can do this.

But you must get in the game now.

About the Author

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.

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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.