November 4, 2013

Trending now . . .

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I must admit, I’m not much of a hipster and I don’t know what a hashtag really is. I’ve tweeted once in my life, and it was for a very uncool purpose (I was at a conference and they had a gimmick where attendees could tweet songs they wanted to hear played in the conference halls; the music was very loud and inhibited networking; my sole tweet was asking the DJ to turn the music down).

But while I’m not particularly trendy, I do have a sense for what’s trending now in the ICD-10 world and the key topics being debated. Below is a list of the hot topics, in no particular order.

2014 Program Budget

It is budget season for many organizations and our clients’ ICD-10 programs are fighting for budget for 2014. Due to several factors, there seems to be a lot of internal strife as executives are asking for reduced funding for 2014 for ICD-10 programs (changing the trend from 2012 to 2013, which saw increased budgets), while ICD-10 program leaders are trying to retain as much budget as possible.

 

With no shortage of work to be done (completing remediation, testing, preparing for ongoing operations, etc.), it will be interesting to see where budgets wind up. Perhaps more on that in an ensuing article . . .

How Much Effort to Put into Testing

Payers are starting to wind up pilot programs for testing and are gearing up for large-scale testing with their providers. Providers are establishing dual coding capabilities and preparing for the ramp-up of test processes.

With so many trading partners to test with, providers and payer counterparts are facing the practical realities of needing to bound the testing activity to the right trading parties and for the right amount of test cases (with available resources being the gating factor). There is much debate about what’s sufficient from a testing perspective and how to achieve desired testing results without overdoing it.

Step Down vs. Step Up

As transactional system remediation is coming closer to completion, focus is now turning to analytics and how to trend in an ICD-10 world while the bulk of the historical data is still in ICD-9. We’re hearing more and more clients evolving their thinking towards stepping new transactions down to ICD-9 and trending in ICD-9 for some reasonable period of time, and fewer clients considering stepping their historic ICD-9 data up to ICD-10.

Will the Date Stick?

Now that ICD-10 is less than a year away, there is a lot of discussion about the potential for the date to be changed again or for the government to establish (as with HIPAA 5010) grace periods where the mandated date is still in effect, but won’t be enforced. Most people believe that the date will stick, but there will be at least one (and probably more) 90-day grace period.

Contingency Plans

Not all ICD-10 programs are going swimmingly. Our clients are faced with the reality that some of the work streams for ICD-10 are unlikely to finish in time. Various levels of contingency plans are being defined and considered seriously.

About the Author

John Wollman is the Executive Vice President of Healthcare for HighPoint Solutions, a Management and Information Technology consulting firm focused on Healthcare and Life Sciences.  John is responsible for HighPoint’s Healthcare industry group, catering to Payers and Providers.  John is a recognized expert in several healthcare business domains (Reform, HIPAA 5010, ICD-10, Platform Strategy) and technical domains (Master Data Management, Analytics).  Since graduating from Duke University, John has held executive level positions at consulting and technology companies over his 25 years in business.

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