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Providers: Confirm payers, EHR vendors are preparing for ICD-10

Interviewees offer advice on stacking the deck to make sure payers and EHR vendors don't let providers down in 2014 ICD-10 transition.

This is a two-part look at how healthcare providers can ready their IT resources for the ICD-10 transition set to take place Oct. 1, 2014. The first part looks at the provider, payer and EHR vendor perspectives on preparation.

Despite the complex challenges ICD-10 may present to health IT -- considering the three-way relationship among providers, payers and the software vendors preparing their applications for the 2014 transition -- there are ways providers can stack the deck in their favor, or at least minimize the magnitude of problems that will eventually occur.

Consultants and other ICD-10 leaders said that the more proactive providers lean in on payer and software vendor partners, the more likely they are to get potential problems addressed in advance of the switchover before revenue streams are disrupted. They offered advice for providers who are preparing for ICD-10.

Derek Dunn, athenahealth Inc. process innovation director and research and development lead for the company's ICD-10 support, said to not ignore ICD-10. Despite the American Medical Association's fierce opposition and CMS twice delaying the ICD-10 transition from 2011 to 2014, Dunn reminded attendees at athenahealth's user conference that CMS director Marilyn Tavenner has been publicly adamant in her declarations that there will be no further procrastination. Later, he told SearchHealthIT that the only thing he believes could possibly stop or delay ICD-10 is Medicare itself not being ready.

Mark Jahn, healthcare solution vice president for Atrilogy Solutions Group Inc., said providers typically put ICD-10 management under IT or health information management departments. The first thing they need to understand is that ICD-10 implementation is roughly 80% a business-process problem and 20% IT. The first task for these teams is to measure current revenue management performance under ICD-9 so there's a baseline target after the ICD-10 go-live. If IT staffers aren't quite up to that task, finding assistance or training in testing and project management skills should be sought when preparing for ICD-10 implementation.

"Ride herd" on software vendors, Jahn added. If a vendor doesn't appear to be keeping up with ICD-10 implementation or, worse yet, may skip it altogether, consider replacing that system. Don't just confirm it's happening; ask pointed questions about how the upgrade will happen and get timelines. Ask your peers if the vendor plan makes sense for your organization. "The devil's in the details," he said.

A lot of hospitals don't have the analytics capacity to manage that level of denials. These are things they need to address before ICD-10 goes live.
Mark Jahnhealthcare solution vice president, Atrilogy Solutions Group Inc.

Sam Ho, M.D., chief clinical officer for UnitedHealthcare, UnitedHealth Group Inc.'s health benefits division, seconds that notion. He advises provider customers to demand that EHR vendors produce a detailed written plan showing how they are managing the project that includes timelines for system upgrades, outlines of their testing plans and the availability of customer training. That goes double for software vendors outsourcing ICD-10 support, he said; they should demand to see the subcontractor's game plan in detail.

Train physicians not only on the gestalt of documentation that justifies using common new ICD-10 codes, but also on how the EHR software you currently use identifies, edits and looks up codes through diagnoses lists. Each EHR system works differently and finding those features isn't always straightforward. Shannon Thompson, practice manager for Purchase Gastroenterology Associates PSC of Mayfield, Ky., added: While physicians aren't coders themselves, hiring on-site ICD-10 physicians for training lasting as short as a half-day could help ease the transition and give docs an understanding of how "ICD-10's more detailed documentation" will translate to their individual workflows.

Among providers, Dunn said, 50% use fewer than 20 different codes in their claims, and 95% use fewer than 50. Focus on those frequently used codes and don't train physician and coding staff on all of ICD-10. "This is not Mount Everest that we're climbing together," Dunn said to an audience of customers.

What more can providers do? Either set up data analytics to watch payment trends and manage what could be up to a 20% claims-denial rate or find a cloud vendor to which you can outsource that task.

"A lot of hospitals don't have the analytics capacity to manage that level of denials," Jahn said. "They don't know where the denials are coming from -- is it a particular payer, is it a physician who isn't documenting properly, is it a coder? These are all things they need to address before ICD-10 goes live."

Let us know what you think about the story; email Don Fluckinger, news director, or contact @DonFluckinger on Twitter.

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