Health Language Blog

Are You Ready for the ICD-10 Conversion?

Posted on 04/03/15


How many times has your ICD-10 leadership team asked themselves the dreaded question: Are we ready for ICD-10 conversion? With the senate scheduled to vote on a permanent fix of the reimbursement formula for Medicare physicians in a couple of weeks (this was the legislation that delivered the ICD-10 delay last year), October 1, 2015 looks to be the deadline the industry is racing towards.

The clock is ticking and there’s little time left, especially for those healthcare organizations that find themselves behind schedule. In fact, many healthcare providers have delayed critical impact assessment and testing tasks that they now intend to conduct in the nine months prior to the October deadline.

This conclusion is borne out by a recent readiness survey conducted by The Workgroup for Electronic Data Interchange, which shows that many providers have delayed their ICD-10 tasks to 2015. This will push the timeline to complete implementation and testing work closer to the deadline date, and is causing anxiety across the industry.

Released last September, the survey relied on 514 respondents consisting of 324 providers, 87 vendors and 103 health plans. The survey’s findings revealed that about 50 percent of providers said they’ve completed their impact assessment. However, about two-fifths of providers responded that they either did not know when they’ll complete their impact assessment, or that they expect to complete this task in 2015.

The survey also indicated that ICD-10 code testing presents significant challenges, especially for smaller providers. The results showed that about one-third of providers said they’ve begun external testing.

However, more than 50 percent responded either that they do not expect to begin external testing until 2015 or responded that they did not know when they’ll begin testing.

Further analysis shows that more than 50 percent of larger providers had begun external testing, while for smaller providers a majority did not plan to begin external testing until 2015, or said they didn’t know when they’ll begin conducting ICD-10 testing.

If you feel your ICD-10 work has become too complex you’re not alone. As a vendor that has worked with providers, payers and other vendors, we feel your pain, but we also want you to know that the best way to implement a readiness strategy is to leverage claims analytics software, which analyzes claims data to identify potential high-risk reimbursement areas.

By using our analytics software with assistance from our team of skilled experts, you’ll be able to conduct a gap analysis and prioritize your dual-coding and chart review activities on areas with the highest risk of financial impact.

To accomplish this, our tools  enable you to simulate DRG shifts by taking 837I historical claims and simulate ICD-10 837I using the MS-DRG and/or APR-DRG grouper. This will help you view important information such as a shift in DRG weight, which might have been caused when a coder entered incorrect information, or a physician entered inadequate documentation at the point-of-care.

You should also consider our ability to conduct outpatient analysis, which will help you sort through professional claims (837P files), and will enable you to identify areas of documentation risk based on individual clinicians in order to mitigate reimbursement issues.

Many healthcare organizations recognize that their coders are faced with the herculean task of scaling-up their coding structure from about 16,000 to approximately 150,000 ICD-10 Clinical Modification (CM) and Procedure Coding System (PCS) codes that they’ll test and retest not only across their hospital’s internal departments, but also with outside organizations.

Typically, hospitals have between 100 and 200 software systems that must be reviewed, but this number can change. With limited time and resources, you’ll have to revisit your ICD-10 plan to find out whether the strategy you developed more than a year ago is still relevant to your healthcare organization’s business operations today.

The challenges of a data driven readiness plans is often frustrated by changes in your business operations that have occurred over the last 12 to 18 months. During this time your hospital may have opened or closed a line of business, engaged a new health plan or begun participation in an Accountable Care Organization.

As a company that has guided many healthcare organizations through ICD-10 conversion work, we recommend that you develop specific goals and objectives immediately.

At this point you will know those individuals who are capable of leading specific ICD-10 projects, and you should identify a leader who will be responsible for managing and coordinating all ICD-10 related projects.

Remember, collaboration is a key factor for success. You’ll need to discuss with your vendor your business needs and the software products to help you achieve your goals. You’ll also want to set timelines in your remediation plans and include vendor tasks in project management processes.

Along with your vendor you’ll need to establish a schedule to test your systems and remediate when interoperability issues are identified. This should be done as early as possible.  Finally, develop a readiness determination that outlines the need for corrective action and presents detailed plans on what to do next.

By leveraging a team of skilled coders and the right software tools, we can help you stick to your plans, your testing schedules and your goals so that your physicians and your organization can adapt to the increased specificity of ICD-10.

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


Topics: ICD-10

About the Author

Brian Diaz is the Senior Director of Strategy, Health Language, part of Wolters Kluwer, Health. Brian has over 17+ years of leading product and marketing teams for SaaS-based healthcare companies focused on interoperability, data quality, and diagnostic imaging. Brian has a computer engineering degree with the University of Minnesota.