Health Language Blog

Five Tips for Selecting a Vendor for the ICD-10 Transition

Posted on 05/06/15

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As you plan for a successful and timely ICD-10 transition strategy, one of the most important decisions you’ll make is selecting a vendor that will provide the skills, technology, and project management expertise necessary to complete your ICD-10 conversion work by the October deadline.  

To succeed, you’ll need a vendor to evaluate your operations, identify risk exposure and create a remediation plan that addresses areas that need to be fixed. One very important aspect of planning for the transition from ICD-9 to ICD-10 focuses on financial mitigation strategies that eliminate claims rejections and delayed payments.

While ICD-10 claims testing is improving across the industry, evidence suggests that many healthcare organizations still struggle with claims processing that involve complex ICD-10 codes. Earlier this year, during a recent round of end-to-end testing between the Centers for Medicare and Medicaid Services and 661 participating providers, billing agencies and clearinghouses, 19 percent – or 2,700 claims – were rejected due to errors that were, in part, caused by invalid submissions of ICD-9 or ICD-10 diagnosis or procedure codes.

If you don’t prepare for ICD-10 in time, you may be one of the many healthcare organizations that CMS experts estimate will suffer declining cash flow and a loss in revenues during the initial roll out period. In fact, CMS also predicts that during the post-implementation period, denial rates will increase by 100 percent to 200 percent with a corresponding increase in accounts receivable days by 20 percent to 40 percent.   

As a vendor that has helped many providers work through ICD-10 code conversion and claims processing work related to the transition, we understand that providers want to mitigate financial risks as they work through the complexity of ICD-10 implementation. With little time left you’ll need to consider engaging a vendor, and when you do here are a few questions to consider:  

Does the vendor use a claims analytics tool that can pinpoint potential reimbursement risks?

When you evaluate a vendor’s software or a consulting service you want to know if their methodology can identify reimbursement risks down to the code level. This includes software that can recognize high risk, high-volume or high revenue codes. For example, analytics tools should spot potential changes in DRG weight, and there are many to speak of. For instance, the original ICD-9 claim indicates a principle diagnosis of major depressive disorder, unspecified degree. In the following ICD-10 claim, however, the code indicates a major depressive disorder, single episode, unspecified. This difference causes a DRG shift and decrease in DRG weight. Examples like these require you to seek a vendor that offers analytics and reports that can reveal reimbursement risks and clinical errors while providing one-to-one relationships when translating ICD-10 codes back to ICD-9.    

Does the vendor have the ability to separate and break down its analysis by organizations and service lines?

You’ll need greater visibility and transparency into your clinical, financial, billing, payer and third party lines of business. Analyzing these systems helps you keep track of the code conversion work between departments and across businesses.

Does the vendor offer a long term solution to accommodate frequent and large scale code updates?

ICD-9 and ICD-10 codes will experience updates over time. Integrating an enterprise terminology platform can help ensure your claims analytics platform is utilizing current and up-to-date codes, which will provide a safeguard to you as you strive to reduce errors. 

Can the vendor provide references?

You want to pick a vendor that has a track record of success and is known among healthcare CIOs, IT managers and industry leaders. If your ICD-10 remediation projects are not completed successfully your organization will face serious repercussions. Given this, make sure your potential partner has ICD-10 project experience.

Can the vendor provide clinically experienced and certified personnel?

A vendor that possesses in-house AHIMA ICD-10 certified trainers and coders, nurses, physicians, PHDs and medical informaticists is a vendor that can offer you the smoothest ICD-10 conversion for your organization. 

With more than a decade of international ICD-10 experience, our technology, skilled coders and well qualified clinicians can help you with your ICD-10 projects.

Our analytical tools can address potential high-risk codes and claims well in advance of the ICD-10 deadline, and through our ICD-10 remediation service we help providers identify DRG shifts so they can take appropriate action.

We also possess a strong understanding of standard terminologies and how to create clinically-equivalent relationships between ICD-9 and ICD-10. Furthermore, our staff of AHIMA-approved ICD-10 trainers and certified coders, medical professionals, PhDs, and medical informaticists can help you convert to ICD-10 by the October deadline.

Today, we can build the foundation for a healthcare organization that mitigates risk, improves clinical and financial documentation and enhances business processes across your business operations so that tomorrow your healthcare delivery system can succeed and thrive using the ICD-10 coding structure.  

Webinar: ICD-10: Leveraging Claims Analytics to Mitigate Risks  

Topics: selecting a vendor

About the Author

Deborah Szymanski Deborah Szymanski RN, BSN is an Account Manager and Clinical Specialist at Health Language. Deborah started her healthcare career as a nurse in the Emergency Department. Deborah has spent the last six years working in medical software, yet still is very involved in the ER nursing field.