Industry Experts Sound Off

A proposed rule from the U.S. Department of Health & Human Services requires all physician practices and other providers to adopt a new ICD-10 code set by 2011, and use it for coding diagnoses on all HIPAA standard transactions. So we asked information technology experts from the ASC industry to respond to this question:

How can facility owners/operators mitigate the challenges and costs associated with potential practice management and billing system software upgrades?

Prepare now! Establishing cross-functional transition teams and plans now will help ASCs identify the impact of ICD-10 on key business processes. Begin speaking and negotiating with both payors and vendors to gauge their preparedness and determine what cost they plan to pass along to clients. If you haven’t yet automated procedure documentation and coding, do so now, as it will cut down on the time and cost of comprehensive staff education. Every vendor will likely have a different plan, timeline and cost structure. Finally, designate a monitor. By designating one individual to monitor changes to the mandate, an ASC can ensure the most appropriate use of resources to achieve compliance in a timely manner.

Sean Benson

Director of Marketing

ProVation Medical/ Wolters Kluwer Health

ICD-10 coding should not be a surprise to anyone in the healthcare management industry since it has been around since 1999 and its predecessors go back as far as 1900, when ICD-1 was implemented. The major challenges facing facility owners and operators will be in educating their clinical and coding staff to the new coding standards, dealing with the phased in adoption by different insurance carriers as with any new standard, and the readiness of their software vendor. The benefits projected by HHS are: more accurate payments for new procedures; fewer rejected claims; fewer improper claims; better understanding of new procedures; improved disease management; better understanding of health conditions and healthcare outcomes (no monetary estimate made); and harmonization of disease monitoring and reporting world-wide.

Ron Cousino

Director of Client Relations

Experior Healthcare Systems

I believe there are three actions that an organization can begin that will reduce the impact on converting to the ICD-10 code set. First, begin dialogue with your IT vendor now. Make sure they have a well-defined plan on how they will meet the requirements for filing claims and contingencies for the inevitable problems that will arise. Secondly, identify your primary payors and begin dialogue with them as soon as possible. Make sure your IT vendor is party to those conversations, too. There are going to be some payors that switch on schedule, others that may migrate earlier or later—you and your billing system have to be ready for those challenges. Finally, staff education will be critical. Understanding the terminology and the requirements will help spot problems before they can affect your operations and cash flow.

Craig Veach

Senior Vice President of Operations

Amkai

Now is the time to ask your practice management and billing providers about ICD-10 conversion. Ask if ICD code fields are “hard coded.” If they are: a warning sign. Also, ask about NPI conversion history. Vendors with properly structured systems finished the conversion early: in either 2006 or early 2007. If that isn’t the case: a second warning sign. Another major challenge will be education of coding staff. If your ASC uses a billing vendor, ask about training plans. If coders are on your staff, plan now for a major investment in education and training, and a substantial productivity hit during the transition.

Bill Gilbert

Vice President of Marketing

Advantedge Healthcare Solutions

The new ICD-10-CM codes incorporate better detail but will also greatly increase the complexity of coding with over 68,000 ICD-10-CM codes versus roughly 13,000 ICD-9-CM codes. This increased difficulty will invariably lead an increase in denied/rejected claims as all parties learn to use the new system. We believe that having digital charts will be extremely important during this transition by allowing facilities to better manage their revenue cycle. We have an application that allows facilities to cost-effectively digitize paper charts and significantly reduce time and effort necessary to resubmit rejected/denied claims. This faster turnaround results in quicker reimbursement and greater working cash flow to the center. The new coding system is necessary and we are working to make the transition as smooth as possible for our partners.

Jeff Blankinship

President and Chief Executive Officer

Surgical Notes

According to the World Health Organization (WHO), “It is not possible to convert ICD-9 data sets into ICD-10 data sets or vice versa. ICD-9 has 6,969 codes while there are 12,420 codes in ICD-10 (14,199 with the fourth-character place of occurrence codes in Chapter XX (External Causes of Morbidity and Mortality).” In our software system, we already accommodate the use of the fourth character in the ICD-10 code set. HST already has one strategy in place to mitigate the transition to ICD-10. One important point that may be missed in this discussion is that the payors and Electronic Claims Clearinghouses must also update their systems to properly handle the ICD-10 code set.  During this transition period, ASCs be on heightened alert to process any rejections and their associated causes. The best mitigation is for ASCs to be well-informed, educated and have processes in place that the entire business office staff can follow.

Tom P. Hui

President and Chief Executive Officer

Healthcare Systems and Technologies

Facility owners and operators need to confirm with their billing and practice management software vendor if their existing system will support both ICD-9 and ICD-10 and replace it with one that will have the capability prior to 2011. As with the NPI transition, many carriers may not be able to convert to the ICD-10 diagnosis system by the deadline and may still only support ICD-9. Software systems will need to support both versions and provide the capability to select either one, so that claims can be submitted to the carriers in the right format to ensure that they will be processed and paid.

Mel A. Gunawardena

Chief Executive Officer

Medigain

The impact to healthcare IT is vast, touching virtually all functions including registration, clinical, quality, billing and reporting. Vendors must aggressively plan to ensure their products support ICD-10 end-to-end, as well as maintain legacy ICD-9 data. “Getting there” requires far more than modifying fields and reports; applications must also reflect many new provider and payer business rules and processes. Perhaps the largest technology consideration is the pre-requisite move to the X12 5010 transaction set. The transition will require significant application modifications plus extensive inter-system testing to ensure processes and workflow are not interrupted. The broad scope of this change will be greater than the HIPAA changes of 2003, since the focus on interoperability and the prevalence of interfaces has increased substantially in recent years.

Lindsay McQueeney

Director of Product Management

SourceMedical Solutions