Provider, Payer, Vendor Share ICD-10 Concerns

They have the same goal—convert to ICD-10. But the way to achieve that goal is different for providers, payers, and vendors. Still, while each have their unique concerns regarding the implementation, they all must find a way to work together if any plan is to succeed.

That was the overarching message at Monday’s ICD-10 Summit session “Three Roads, One Destination: Providers, Payers and Vendors Speak Out.” During the session, representatives from the payer, provider, and vendor world laid out their chief specific concerns when it comes to ICD-10, as well as ways the three siloed groups could better work together toward the end goal of ICD-10 implementation.

Joanne Romasko, RHIA, CPC, CHDA, director of medical economics at Blue Cross Blue Shield of Montana, represented the payer on the panel. She said ensuring “neutrality” in various forms is a payer’s primary ICD-10 concern. This includes neutrality of provider claim payments due to DRG weight, neutrality of member benefits to ensure contracts don’t need to be redrawn, operational neutrality due to additional administrative functions, and the overall financial neutrality of using a new code set. If neutrality is not achieved in the transition, contracts and relationships would need to be redone, Romasko said.

Developing accurate crosswalks and mapping ICD-9 to ICD-10 is most payers’ primary focus this year in order to evaluate that neutrality. Then comes adequate testing of the new code systems. While most payers and vendors seem to be on track for compliance, provider readiness is a concern for some. For this reason, a compliance delay might be necessary.

“We are somewhat excited about the delay since it gives us more time to do testing,” Romasko said.

The provider angle was represented by Keith Olenik, MA, RHIA, CHP, ICD-10 project manager at Cook County Health and Hospitals System based in Illinois. Many providers have decided to merely slow their ICD-10 conversion in light of the potential one-year compliance delay, versus stopping and starting altogether which would waste both time and money.

However, providers need to pick up their pace of implementation, as payers and vendors appear to be ahead.

“I know we are not supposed to be excited about this delay; some did give a small sigh of relief that there is more time to get ready,” Olenik admitted. “That said, you have to continue to move forward.”

Though most providers see ICD-10 as critical for success, the implementation is taking a back seat to meaningful use, Olenik said. Also, IT is driving the transition more than HIM, the department most impacted by the conversion.

Coders are another chief concern. Productivity could go down drastically during ICD-10 implementation, to the point that providers should consider implementing computer-assisted coding and clinical documentation improvement programs to help reclaim some of that loss.

Training coders should be seen as an investment and tied to other incentives to ensure trained coders don’t leave for other facilities.

Providers need to ensure they budget properly for another year’s worth of implementation due to the delay, Olenik warned.

“You might need to shift some money out of this year and move it to next year so you don’t run out or have it taken away,” he said.

Vendors were represented by Roy Foster, the director of regulatory compliance practice for Cerner. Most vendors have made the transition to ICD-10 their top priority, in part because providers and payers can’t fully move forward with their implementation plans until their vendors are ready. Vendors are very concerned about provider readiness, especially physician readiness, since providers need to work with vendors to transition systems. But for some providers it is the opposite. For those concerned about vendor readiness, Foster suggests providers use the possible ICD-10 delay to contact their vendors and finalize plans.

Some questions to ask vendors include:

  • Will the application be updated or sunset?
  • What is the timeline for development, testing, and go-live?
  • Can you provide a complete implementation checklist and milestone tracking?
  • Will there be a new service level agreement or new contract?

“We want all of our clients to survive ICD-10 so we can get back to business,” Foster said.

Improved communication between all three parties was cited as a way to help everyone reach implementation.

“Communicate, communicate, communicate,” said Romasko. “Make sure everyone you work with is ready for ICD-10.”


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