Industry Accelerating Efforts toward ICD-10 Transition

March 11th, 2013 / By Ann Chenoweth, MBA, RHIA, FAHIMA

Last month, AHIMA received a letter from CMS confirming their commitment to the October 1, 2014 compliance date for ICD-10.  This commitment was reinforced during last week’s HIMSS conference where Marilyn Tavenner, Acting CMS Administrator, communicated that ICD-10 would not be delayed further.

We are seeing industry associations such as AHIMA, HFMA and HIMSS now accelerating their efforts to prepare their members for the inevitable ICD-10 transition.    ICD-10 readiness through industry collaboration and testing was a key agenda topic the last two weeks at both the HFMA Dixie Conference and the HIMSS Annual Conference.

During HIMSS, it was especially rewarding to see over 100 industry stakeholders get up for an early 7:30 a.m. meeting of the HIMSS/WEDI  ICD-10 National Pilot Testing Task Force.  This group has been working hard over the last few months pulling together health systems, physician groups, associations, clearinghouses, payers, vendors and consultants with the common goal of executing nationwide collaboration and end-to-end testing of ICD-10.    Rex Health, Cleveland Clinic, Banner, BCBS, Wellpoint, AmeriHealth, 3M  and AHIMA are a few of the participating organizations engaged to ensure end-to-end testing of ICD-10 can be accomplished and best practices identified over the next 12 months. 

Simply stated, the stakeholder groups will perform the following tasks to complete end-to-end testing of ICD-10:

  • Health systems are currently submitting a total of 100 test cases with clinical documentation and ICD-9 codes attached.
  • AHIMA trained ICD-10 professionals will code the ICD-10 codes from the clinical documentation provided.  If documentation specificity is lacking, the record will be returned to the provider for further clarification. These codes are peer reviewed to ensure coding accuracy.
  • Providers’ HIS/PMS systems will create and send the ICD-10 claims to the clearinghouses for conversion to 5010.
  • Clearinghouses will submit the 5010 to the payers who will adjudicate the claims before sending the 835s back to the providers.
  • Providers’ revenue cycles will conduct an analysis and validate the 835s.
  • Banks will be given EFT remittance files to complete the end-to-end testing process

The benefits associated with performing end-to-end testing are many.  First of all, it is important to understand if there are specificity gaps in the clinical documentation needed to assign the ICD-10 code.  If so, physician education can take place well before the ICD-10 compliance date.  Coders also need practice coding in ICD-10 to minimize disruptions to the revenue cycle come October, 2014.

Validating the full execution of the ICD-10 processes with your business partners is instrumental in verifying that the providers, payers as well as the external trading partner’s systems, are integrated, interoperable, and ready to accept and process the new codes and formats.

Finally, financial integrity testing will ensure that the provider is not underpaid or overpaid due to the use of ICD-10 codes.  Benefit neutrality testing ensures that the ICD-10 implementation will not result in either over-or under-usage of benefits within any particular LOB/product combination, including medical policies.

The collaborative efforts by so many involved in the HIMSS/WEDI ICD-10 National Pilot Testing Task Force are to be commended.  This work will serve as a model for how providers, payers, vendors, and numerous other stakeholder groups can work together to successfully transition to ICD-10.

Ann Chenoweth is Director of Industry Relations and Market Research with 3M Health Information Systems.