The issues around ICD-10 implementation

Physician practices are mostly running behind schedule in their quest for ICD-10 implementation. Surprisingly there also seems to be a strong positive vibe amongst most of them to achieve it before the switch deadline of Oct. 1, 2014. A survey done in this field has suggested that the industry is far behind milestones otherwise required by the ICD-10 implementation framework. The time available in their disposal is about nine months and given the devastating consequences predicted by various stakeholders, one is compelled to think whether it is not already time for providers to pull up the socks and get started with the act. In its current state, the coordination which is expected between practices and software vendors, health plans partners and clearinghouses is either missing or evidently not at a level which can foretell a seamless implementation. The one concern which seems to be common across all of these practices is something related to the fallout of the implementation and not how to achieve it. There is a strong apprehension that the switch will result in claims’ processing delay or denial which ultimately will have an effect on cash inflow.

medical software developmentFollowing various rounds of discussions between industry leaders, there seems to be 3 major recommendations which have come up for physician practices as they gear up for the deadline which is inevitable now. They include the following:

  • Checking the accuracy of the mapping program: This will be possible by getting a demonstration from the vendor. Since the claim submissions eventually will be dependent on the accuracy of the mapping, it makes sense to check them beforehand. Infact getting the coders and health information professionals to be involved in understanding the possible changes in workflows is not a bad idea.
  • Getting hands-on experience for the coding and billing staff members: Real life scenarios should be staged and the staff made to go through the process.
  • Updations of EHR in order to remove the inactive problems from the problem list: All ICD-9 codes which have ever been used should not be blindly imported without checking on the incorrect and unresolved ones.

Productivity is expected to take a nosedive owing to this change. Providers are expected to have a permanent decrease in productivity in the range of 20 to 50 percent due to the granularity of ICD-10. The type of providers who are likely to be impacted the most with this change would be the ones dealing with a broad range of conditions like primary care, emergency orthopedics, cardio to name a few. Also, this impact will be felt irrespective of the size of the setups.

Pre-empting the roadblocks that the initiative will run into and the subsequent mess it is likely to result in, the Medical Group Management Association has appealed to the US department of Health and Human services to perform extensive testing of ICD-10 with immediate effect . They have also requested them to share the outcomes of the testing with vendors and providers. Primary reasons put forth in their defense include the following points:

  • It will allow the software developers the time and the knowhow to configure the technology for physician practices
  • Identified before the switch deadline, it will allow the relevant stakeholders to make the required adjustments to the workflows and systems
  • Allow practices to understand fully well the effect of the implementation on reimbursement

All the above will go a long way in providing some level of assurance to physician practices pertaining to achieving seamless processing of their claims post the switch. Since any wide-scale interruption to the claim-processing system is likely to affect the running of healthcare providers, it is of high importance that required authorities take all necessary steps beforehand. A thorough end-to-end testing definitely qualifies as one.

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