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Apr 2 2012   8:56AM GMT

HIT Exchange live chat transcript: Transitioning to ICD-10 codes

Posted by: Jenny Laurello
Claims processing, EHR billing, ICD-10, ICD-10 transition, Live chat, payers, Revenue cycle management

Even with the possibility that the Oct. 1, 2013 deadline for transitioning to ICD-10 codes could change, experts say providers should keep the transition train moving.

Below is the transcript to last week’s live chat with James Truesdale, Partner at The Kiran Consortium Group, LLC and past program director for the ICD-10 Mandate at the Georgia Department of Community Health, where readers were able to ask questions and share their own thoughts about moving to ICD-10 codes.

Have other questions about the transition to ICD-10 codes? Visit the HIT Exchange Q&A forum and ask now!

Chat transcript: March 28, 2012

11:31 Jenny Laurello: Welcome to the Health IT Exchange Live Chat on The Business Implications of ICD-10! We will begin with our chat leader, James Truesdale, Partner at The Kiran Consortium Group, LLC and past program director for the ICD-10 Mandate at the Georgia Department of Community Health, at 11 ET.

11:00 Jenny Laurello: We will begin momentarily. Please ask your questions in the text box below and James will respond to as many as time will allow. Please use #HITExchange as the hashtag on Twitter!

11:01 Jenny Laurello: And we’re live! Welcome to James Truesdale, Partner at The Kiran Consortium Group, LLC and past program director for the ICD-10 Mandate at the Georgia Department of Community Health, who is here to answer all of your toughest ICD-10 implementation questions!

11:02 James Truesdale: Thanks for having me today! I am excited to be here!

11:02 Jenny Laurello: First question for you James: How do I get my CEO and CFO to understand the real impact of the switch to ICD-10 so they can prepare for the accounts payable problems that might occur?

11:06 James Truesdale: It is best to explain the impact of the changes quantitatively rather than qualitatively. This approach can be accomplished by running testing scenarios to see impacts to claims processing. The foregoing would be accomplished by establishing the appropriate test beds with emphasis on historical claims data, benefits data and Reimbursement data. Essentially, these activities would help to validate payment and benefit neutrality post conversion. This will enable the CEO and CFO to prepare for accounts payable issues.

11:07 Comment From Cole Alexis: Is there any advantage at all to waiting to implement ICD-10 coding at the last possible minute and still meet the (new) deadline)?

11:11 James Truesdale: That approach could be problematical. Let me tell you why.

11:13 James Truesdale: I do not see an advantage to waiting until the last minute to implement the ICD-10 coding. There will be substantial testing necessary to validate the new codes which will require lots of coordination with both your internal and external stakeholders. Additionally, you will need to ensure your coders are familiar with the new codes. Hence, you do not want to wait until the last minute to train your staff to undertake any changes to bill payments. Therefore, you want to implement as soon as it is feasible.

11:14 Comment From Steve Sisko: In regards to Jenny’s intro question, I would also suggest to you C-suite that a monitoring plan be developed. This would include collecting baseline data on cost pre-ICD-10 with frequent post-ICD-10 analysis to detect cost variation at the earliest point in time. This information will allow for further analysis and action to be taken to validate the coding for accuracy and, if needed, take action to correct coding or modify pricing.

11:14 Comment From Steve Sisko: Also, develop a baseline for your firm’s key measures and reports. Compare pre-implementation and post-implementation measurements to determine the impact of the transition. Significant variations in measure should be validated before releasing the reports to ensure inaccurate data is not being reported.

11:15 Comment From Cole Alexis: I certainly don’t advocate waiting! However, do you know of any healthcare providers that expect to implement ICD-10 coding and processing and yet intend to postpone their implementation date for reporting as long as possible?

11:17 James Truesdale: Steve, Yes, that is a good approach. It provides good insight into the potential impacts to the organization from an As-Is To-Be perspective

11:18 Comment From Steve Sisko: And if you wait until the last minute and need external help, then good luck finding resources – at least any that you can reasonably afford. :’)

11:19 Jenny Laurello: Will the delay give software vendors more of a reason to drag their feet and we’re going to be in another fire drill 6 months out before the eventual deadline, whatever CMS sets it at?

11:22 James Truesdale: Yes, some vendors will drag their feet. We all love to procrastinate! However, smart vendors who are behind will take this time to play catch-up. Those who are moving toward ICD-10, it might best for them to spend time ensuring their systems changes have been properly tested and validated. Without a doubt some vendors will not use this time wisely while others will prepare themselves for this transition.

11:22 Comment From ErnieCIO: I had just convinced my CFO to sign off on additional budget for ICD-10 resources, and then it gets delayed so I am sounding like chicken little in meetings about the ICD-10 transition. Any advice on convincing him to stay the course for the implementation? In this chat we all know it’s coming, but to him it looks…like less of a priority

11:27 James Truesdale: Ernie, I will emphasize the financial impact of not being ready for ICD-10. There is also a tremendous strain on resources across the industry. So, any time invested in those current resources will be lost. You do not want to re-orientate your team to the project nor lose critical resources to other projects. You must speak to the pain points of not staying on course as well as the likelihood of losing resources to other project. As you are aware, there are many competing HIT projects that Health Care organizations are trying to address simultaneously.

11:28 Comment From Cole Alexis: @ErnieCIO: If the delay does not materially affect your choice as to whether you are meeting the needs with inhouse vs. outsourced resources, moving ahead is the right thing to do. I think the focus of your message back to your CFO should be Risk management. Very few of the other initiatives on your plate have such wide sweeping change impacts on your organization.

11:30 Comment From SanFranMan: I work in a hospital billing department, working in ICD-10. Some of our smaller payers seem to be behind in testing and implementing ICD-10 transaction capability. Is that true all across the U.S.?

11:34 Anne Steciw: Our guide on ICD-10 has some great information about implementation and the impact on the U.S. health industry:

11:34 James Truesdale: Not sure if this is true across the US. However, many organizations are hampered by what to do to address the changes. For payers, the true impact is not fully understood, so it appears they are still trying to figure things out. The changes to ICD-10 will allow payers to take a second look at their existing contracts so to evaluate the financial impact to their organizations. This analysis takes times to complete causing an apparent delay across the industry.

11:35 Jenny Laurello: Note: James will respond to as many questions as time allows. Please submit in the text box below, where we will then select and push live (we are seeing the Qs, but not all can be published). Thank you!

11:35 Comment From ErnieCIO: Cole, so you’re saying I can put it in terms like: “ICD-10 brings a ton of risk — like making a big bottleneck in accounts payable. The delay just gives us more time to analyze and mitigate more risk than we otherwise would have.” Something like that?

11:35 Comment From Steve Sisko: In regards to project delay: If a project was started and put on hold, I’d make sure that any information and efforts already completed and/or underway were properly mothballed so as to minimize any restart time. And you might consider moving forward with some aspects of the ICD-10 effort that can be used with other projects – there are a lot of synergistic efforts that can provide immediate value for ICD-10 and longer term value for other projects and the business in general.

11:36 Jenny Laurello: James, do you think that ICD-10 will be delayed even further? I know it’s speculating, but what is your opinion on that? Advice for providers?

11:38 James Truesdale: Yes, I do believe the ICD-10 will be delayed but for no longer than a year. Because, a delay that goes beyond a year will cause many of the organizations that have efforts underway to lose both resources and momentum. My advice to providers is to take this time to focus on Clinical Documentation and Training of staff given the significant impact to these areas.

11:39 Comment From Cole Alexis: @ErnieCIO, yes but ideally you should be working with your CFO to prioritize initiatives in terms of not only revenue impact, capital expenditures and cost savings. Typically, ICD-10 has huge training impacts, much more so than other initiatives.

11:39 Anne Steciw: Reactions to the ICD-10 delay are a mixed bag:

11:39 Comment From Steve Sisko: What do you think are some of the efforts that could be outsourced vs. kept for in-house staff? (for the provider-side, not payer)

11:43 Comment From Cole Alexis: @Steve – Change management and training are the obvious choices. Most providers will have a hard time providing just-in-time training and quality testing with inhouse resources.

11:45 James Truesdale: Steve, I think you can outsource testing because it is not a core activity for the organization. You also want to demonstrate to your organization that your changes have been properly vetted and validated.

11:46 Anne Steciw: Our 5-part series outlines what needs to be done to meet the approaching ICD-10 deadline

11:46 Comment From Willie Williams: How do you see tools playing a major role in assisting with the conversion from ICD-9 to ICD-10?

11:51 James Truesdale: Willie, I see tools playing several roles especially with regards to assessing the potential impact of transitioning from ICD-9 to ICD-10 so that key information is captured, analyzed and then used appropriate. The use of online tools for training of the new codes sets will be key given the shortage of ICD-10 Training resources. Last, given the detailed nature of the endeavor, the use of automated remediation tools as well as on-line training solutions will also play a vital role in this process.. Essentially, tools will assist the industry in understanding the potential impact as well as moving the US toward ICD-10 compliance in a structured manner.

11:52 Jenny Laurello: How is your previous employer dealing with the ICD-10 delay, since you led that implementation for the Georgia Dept. of Community Health?

11:56 Comment From Steve Sisko: @ Willie Williams There are also some financial modeling tools that risk-bearing providers and providers paid via DRG’s, case rates, etc. can use to model impacts to contracts and revenue streams.

11:57 James Truesdale: They are moving full steam ahead with ICD-10 for several reasons. They are working on several competing efforts that complement the activities associated with completing ICD-10, namely Meaningful Use as it pertains to providers. They are continuing to use this time to educate both internal and external stakeholders about the project and the impacts to the various groups. They are also making sure the requirements that have been gathered have been properly vetted so that all impacted groups have been accounted for.

12:01 Jenny Laurello: Please note: this will be our last question

12:01 Jenny Laurello: What are the main areas of impact in the revenue cycle?

12:02 James Truesdale: There will be increased payment delays from payers as well as overall decreased cash flow. Last, there will be increased documentation requests to substantiate medical necessity.

12:04 Jenny Laurello: That’s all folks! Please direct all questions to the Health IT Exchange Q&A forum:

12:04 Jenny Laurello: Thank you all for your time and questions, and thank you to our wonderful chat leader James! The chat transcript will be available here immediately afterward. Have a great day!

12:06 Anne Steciw: Thanks for participating everyone! We look forward to having you join us during our next chat.

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