Dec. 19, 2013


New ICD-10 resources for providers from CMS

The Centers for Medicare & Medicaid Services wants to remind you that the ICD-10 compliance date for entities covered by the Health Insurance Portability Accountability Act (HIPAA) is less than a year away, so it’s important for healthcare providers, hospitals, payers and vendors to prepare for the transition now. All entities covered by HIPAA are required to make the transition, not just those who submit Medicare or Medicaid claims. CMS has released new educational resources to help providers with each phase of the ICD-10 implementation process, including: Online ICD-10 Guide, Introduction to ICD-10, Role of Clearinghouses in ICD-10 Transition, Basics for Small and Rural Practices, and an ICD-10 Resources Flyer.

These resources and more, including a sign-up for email updates and access to two free Medscape Education modules, are available through the CMS website at http://go.cms.gov/1bgZi7Q.

Key HIPAA transaction guidance for ICD-10 codes

The Workgroup for Electronic Data Interchange (WEDI) has released a new ICD-10 issue brief co-written with ASC X12 entitled, “ICD-10 Impact to HIPAA Transactions.” The issue brief was developed to help the healthcare industry better understand where to focus transaction testing to ensure that codes are correctly placed and formatted within the transactions. The brief is available at http://bit.ly/IVuCPl.

ICD-10 National Pilot Program Outcomes Report

The HIMSS/WEDI ICD-10 National Pilot Program was established as an industry-wide, collaborative concept to assist the healthcare industry in its efforts to prepare for ICD-10 testing. The program was designed to share best practices of, and lessons learned from, early-adopter/early-mover organizations participating in actual financial transaction testing. The Pilot Program used de-identified, real medical records as “medical test cases.” The ICD-10 National Pilot Program Outcomes Report was released on Oct. 23, 2015, and provides:
  • General ICD-10 information important for the ICD-10 novice reader;
  • An overview of the ICD-10 National Pilot Program;
  • Outcomes data from early testing with organizational coders;
  • Best practices from health plan and provider participants; and
  • Awareness and education regarding the outcomes of the pilot program.

Download the full report at http://bit.ly/1d5ea81.

Are you ready? These service providers are

SSI Group, Inc., one of the country’s largest independent medical billing clearinghouses, says that both its clearinghouse services and revenue cycle management solutions are ICD-10 ready and that it is actively involved in testing with provider and payer communities to ensure a smooth transition to the new coding standard. SSI is actively testing ICD-10-based transactions with the payer community by participating in the WEDI and CMS pilots. http://bit.ly/1jukBGu.

RelayHealth Financial, McKesson’s connectivity business, announced in November 2013 that all of its financial connectivity solutions meet the current ICD-10 standards one year ahead of the U.S. federal government deadline. The company also announced an ICD-10 end-to-end testing program at no cost to its customers, so they can initiate testing with their payers. “If ICD-10 were implemented today, we could process our customers’ claims,” says Joshua Berman, ICD-10 director for RelayHealth Financial. http://bit.ly/18ooKXS.

ZirMed, a specialist in health information connectivity and management, is providing a multi-purpose educational and mapping tool as part of its proactive payer and partner strategy that will help clients identify appropriate ICD-10 codes and back-code from ICD-10 to ICD-9. ZirMed is also creating a list of the most commonly used input codes for providers to use as a reference to prepare for the transition. “While the mapping tool provides a ‘quick fix’ to help ease the process, we are also giving our clients the resources and tools so they can learn from errors as quickly as possible and be able to code natively and submit codes correctly the first time,” says Betty Gomez, director of regulatory strategy, ZirMed. http://bit.ly/IHIxHL.

ICD-10 consulting rankings from KLAS Research, Best in KLAS Software and Services

  1. Advisory Board: Advisory Board ICD-10 Consulting (93.8)
  2. 3M: 3M ICD-10 Consulting (90.8)
  3. Deloitte: Deloitte ICD-10 Consulting (89.7)
  4. PwC: PwC ICD-10 Consulting (86.9)
  5. Ernst & Young: Ernst & Young ICD-10 Consulting (79.5)

* Rankings were calculated in December 2012. 2013 rankings will be released at the end of January 2014.

Planning worksheet

To help all providers navigate ICD-10, TriZetto Provider Solutions offers a free ICD-10 Implementation Planning Worksheet that includes a list of preparation steps and suggested timeline for transitioning to ICD-10. Providers can also find other helpful ICD-10 resources at www.gatewayedi.com/icd10.

Can ICD-9 and ICD-10 coexist?

Erik Newlin, director of national standards consulting in Xerox’s Government Healthcare Solutions group, urges organizations to have a system in place that allows ICD-9 to co-exist with ICD-10 in order to ensure business continuity from October 1, 2014, forward. “With an implementation of this magnitude, it is important to be prepared for all possibilities,” says Newlin. Keeping ICD-9 running while ramping up ICD-10 can help ensure a smooth transition because:

  • There is a need for both code sets depending on dates of service or discharge dates.
  • There may be a need to adjust claims after the compliance date.
  • The code sets are used by entities that are not covered under HIPAA, such as Worker’s Comp and other accident insurance. It is conceivable that a few of these may continue to use ICD-9 codes after the compliance date.
  • Some providers may choose to submit paper claims with ICD-9 codes after the compliance date.
  • Organizations can plan for how they will handle implementation issues if one or more of their trading partners is not ready, or if after the compliance date production issues are detected.
Managing external risks associated with the ICD-10 transition

Matthew R. Dutton, a management consultant with Freed Associates, says that in looking at previous CMS regulatory initiatives (e.g., v5010/D.O.), there has never been 100 percent compliance. After October 1, 2014, there will be coding errors, reimbursement errors, and even providers and payers that are not at all ready for the ICD-10 cutover, he says. Whether you are a payer or a provider, Dutton says your organization should consider the following three steps:

  • Create an inventory of your external trading partners, sorting by annual dollar volume (high to low).
  • Reach out to your trading partners and schedule a test of healthcare transactions (e.g., 837 claims and 835 remittances) using claims with ICD-10 codes.
  • Take appropriate steps to insulate your organization by preparing for dual processing and dual coding contingency strategies.

When engaging external trading partners, focus on answering the following, says Dutton: “What will you code?” and “What will you pay?” By using these two questions for your book of business, you will be taking appropriate steps toward managing external risks associated with the ICD-10 transition.


CAC for small rural and community hospitals

The 3M CAC System for Small Hospitals is a simple-to-install and easy-to-use computer-assisted coding (CAC) solution that reduces time-consuming chart review and helps coders identify missing information in physician documentation, making it possible to expedite the coding process without compromising accuracy and compliance. It aims to dramatically reduce the need for interfaces to electronic documentation sources, benefitting small facilities without extensive IT resources. 3M


Treat ICD-10 holistically

SSI has got you covered before and after October 1, 2014. The company’s 10Smart Solution provides smooth ICD-10 conversion and helps protect your financial picture during the transition to ICD-10. 10Smart includes: ClaimSmart Suite, a fourth-generation RCM solution; A/Rchitect, a breakthrough platform that features an Analytics Suite and ICD-10 Assessment Tool; and ClickON ClearView ICD-10, a claim-validation test harness. SSI


Rx decision support code set updated

An ICD-10-CM and ICD-10-PCS revision is available for FDB MedKnowledge, a proprietary clinical drug knowledge program also used for clinical decision support. Clinicians use the codes to record patient problems and when performing drug-disease decision support for drug-disease contraindication screening, screening for drug side effects, drug indications and indication-specific drug dose checking. Since patient profiles will continue to contain ICD-9-CM codes for several years to come, FDB will continue to support ICD-9-CM codes. First Databank (FDB)


Complete, customizable training

Optum ICD-10 Core Education is a customizable, three-level, complete  training program focused on meeting the learning needs of physicians, nurses, coders, clinical documentation improvement specialists and other hospital workers. Levels include: overview training, knowledge-based/skill-transfer and on-the-job training. Supplemental ICD-10 training options are also available, including on-site train-the-trainer sessions, dual coding and post-transition. Optum


Sponsored Recommendations

Clinical Evaluation: An AI Assistant for Primary Care

The AAFP's clinical evaluation offers a detailed analysis of how an innovative AI solution can help relieve physicians' administrative burden and aid them in improving health ...

From Chaos to Clarity: How AI Is Making Sense of Clinical Documentation

From Chaos to Clarity dives deep into how AI Is making sense of disorganized patient data and turning it into evidence-based diagnosis suggestions that physicians can trust, leading...

Bridging the Health Plan/Provider Gap: Data-Driven Collaboration for a Value-Based Future

Download the findings report to understand the current perspective of provider and health plan leaders’ shift to value-based care—with a focus on the gaps holding them back and...

Exploring the future of healthcare with Advanced Practice Providers

Discover how Advanced Practice Providers are transforming healthcare: boosting efficiency, cutting wait times and enhancing patient care through strategic integration and digital...