Anyone on any side of the ICD-10 remediation equation knows that there are a lot of moving parts to the process, and a lot of players in each healthcare ecosystem have a hand in successfully navigating the switch from ICD-9 to ICD-10.
Providers bear the most obvious brunt of the implementation, needing to make sure that codes are correctly mapped from ICD-9 to ICD-10 to ensure their systems are remediated, and that clinicians and coders are up to speed on documentation requirements, how clinicians should code encounters, and following coding guidelines when submitting claims to payers. But in the multi-faceted world of the shift to ICD-10, other players have big responsibilities as well. Payer systems must be up to snuff with processing ICD-10 codes to avoid incorrectly rejecting claims or paying incorrectly. On the provider side, EHR vendors have to be certain that embeded content and maps between clinical terms and ICD-10 are accurate in order to offer intuitive clinician workflows to navigate the new coding terminology.
With so many different players, so many different pieces of software working together, and the added complexity of the codes themselves alongside the technological complexities of integrating EHRs, there is the potential for a lot to go wrong. What is important isn’t just going through the motions and hitting implementation benchmarks. What is important is having an end-to-end system that works.
That’s why it is crucial for providers, payers, and vendors to test their systems together – and to start working on it soon.
Potential Points of Breakdown
Is the EHR software a provider is using and any other pieces of software involved in their coding and billing process functioning to generate ICD-10 codes with the proper degree of accuracy and granularity? Is a provider’s process for submitting claims functional on all sides? Is the payer set up to receive ICD-10 codes in an efficient and effective way that does not result in double-billing or rejected claims?
These are but a few of the potential concerns that may come up as a provider determines its level of preparedness to bill using ICD-10 codes. But those are hardly the only potential concerns.
Systems for providers are as individuated and varied as the types of care they offer. Because of that, the truth is, there could be kinks in a clinic’s system that a provider simply will not know about until the process is tested.
Collaborate to Simulate
That is why Health Language recommends that providers test their entire system from end-to-end. Any software package reliant on ICD-10 should, of course, be tested. But it’s not just a matter of clinicians learning how to use the software correctly. The provider/payer/vendor workflow must be tested, with all parties coming together to make sure that, when the October 1, 2015 deadline comes, everyone is on the same page.
The way to successfully manage this is by:
- Running full simulated encounters.
- Recording what works and what does not.
- Undertaking an iterative, step-by-step approach to assessing and resolving problems that crop up.
Test Early and Test Thoroughly
A network of interconnected systems can behave like a perfectly functioning circuit, or like a row of dominos in which error after error compounds with each step. The former is, of course, the goal.
By working together with all parties involved, a provider can ensure a successful transition to ICD-10. Providers who frontload this work will breathe sighs of relief as they catch errors early and correct them. Those who do not run the risk of facing the frustration and anxiety of snowballing systemic breakdowns, in an environment where both money and patient satisfaction are at stake.
What steps have you taken to test your systems for ICD-10 processing?