Posted by: DonFluckinger
HIPAA, HIPAA 5010, ICD-10, ICD-10 implementation
We’re seeing a lot of pushback against ICD-10 implementation, with the American Medical Association’s “vigorous opposition” at the extreme. Gloom and doom types equate to potential IT disaster to Y2K. Ever since watching T. Bedirhan Üstün, M.D. — curator of the International Classification of Diseases, the master coding set from which ICD-10 is derived – present at the American Health Information Managers (AHIMA) annual meeting last October, a question’s been gnawing at me:
If flipping the switch on ICD-10 come Oct. 1, 2013 will be such a disaster as groups like the AMA claim it will be, then why didn’t it bring down the European and Asian health systems that implemented their own flavors of ICD-10 years ago?
The reporter in me – especially when hearing people couch ICD-10 in terms like “unfunded mandate” and “sky-is-falling” hyperbole – suspects it’s all about politics. During the course of debate in these times, it seems as if people on both the left and right resort to browbeating rhetoric faster than I’ve ever seen in my life. And why not? Reciting the catchphrase du jour requires far less reasoning than a well-constructed, original thought.
“Political rhetoric is exaggerating the ICD-10 issue” is just my hypothesis. Are there any actual IT reasons transcending the theoretical that might concern us about ICD-10? On what basis should the pragmatic, budget-driven CIO planning for ICD-10 involve more than just the usual software upgrade hassle? I’ve posed this question to several experts. Everyone gave me vague theories about what could possibly happen, without actually committing to an actual opinion based on facts.
That is, until I ran into Lonnie Johnson, COO of Zotec Partners, whose company provides business management, coding and revenue cycle analytics services for health care providers, with an emphasis on radiology, anesthesiology and pathology.
His company also created its own medical billing clearinghouse for its physician customers, and conducted extensive, government-mandated HIPAA 5010 testing for electronic transactions with a bevy of payers large and small in advance of this week’s implementation deadline. HIPAA 5010 is a precursor to ICD-10, in that it paves the way for ICD-10 coded claims and reimbursements to flow between hospitals and payers because it adds more data fields to accommodate the more documentation-intensive coding language. The previous standard, 4010, couldn’t do that.
In short: As HIPAA 5010 implementation goes, so goes ICD-10, albeit on a much smaller scale because 5010’s confined mainly to billing and revenue-cycle management software and won’t run the whole gamut of clinical information systems that ICD-10 will.
Johnson’s got a ground-level view of how ICD-10 implementation might work, having tested 5010. Even though Zotec ironed out the HIPAA 5010 bugs with many payers and confirmed its various transactions worked, he’s still worried about bumps in the road as payers update, tweak and troubleshoot their systems for 5010 compliance. He’s not an analyst, consultant, industry observer or agenda-driven association rep; instead, cold, hard business reasons drive his interest in 5010 and ICD-10.
He sees potential difficulties for ICD-10 implementation, more in the United States than the rest of the world, because of our health system’s scale. He suggests that, because other countries have many fewer payers – in some cases, a single payer – flipping the switch from ICD-9 to ICD-10 was probably more straightforward. The U.S. health care system’s mishmash of public, private and mixed insurance carriers poses a much more complex implementation puzzle.
“Here, we’ve got multiple payers, with multiple levels of understanding — and intricacy of systems that are nonstandard for the most part,” Johnson said. “So the ability for all the payers that we deal with to [implement] ICD-10 consistently – that’s where the challenge comes in.”
Large payers were on the ball with HIPAA 5010 compliance, Johnson said, and conducted more robust testing than smaller commercial plans. The latter still worry him – will technical glitches negatively affect his customers’ revenue streams? He’s already advising his customers to plan on disruptions. ICD-10, because it affects more systems for health care providers than 5010, could be more glitch-ridden. That makes sense. Actual IT reasons to worry about.
Note: Johnson’s neither opposing ICD-10 nor predicting gloom and doom. Not at all. It’s just another business problem to solve, right after payers finally nail down HIPAA 5010 compliance. But if gloom and doom happen to come next year with ICD-10, it’s important to create contingency plans, judging on how HIPAA 5010 went. I’m betting Zotec will.