Taking the ICD-10 Transition in an Upp-ward Direction.

As you know, nearly every healthcare organization in the country will be affected by the transition to ICD-10. Did you also know that organizations like banks, brokerages, clearinghouses and even automotive insurers will also be affected by the change?

Tuesday, November 8, 2011

Survey Says Coders’ Salaries Continue to Rise

The ICD-10 transition has created a demand for skilled coders, and with this demand comes a well-paying, secure niche in the job market that will only continue to grow.

According to a recent AAPC survey, coders are predicted to have high job security due to the pressure that the ICD-10 transition has placed on healthcare organizations. As of this date it is estimated that only 9 % of total healthcare organizations have reached the halfway point in their transition processes, coders are expected to rise despite national employment trends.

Coders looking to get into the medical coding arena simply must be medical themselves. The interaction between coders and medical staff is growing, and learning different areas of medicine such as anatomy, physiology or pathology will let coders understand the full definition of the codes. Knowing what several different severities of a disease look like will help a coder prove their worth to an organization by being able to explain the complex nature of ICD-10.

Coders need not waste time memorizing all the new codes, at least not yet. Learning the codes over time while marrying coding skills to those that healthcare organizations utilize on a daily basis will ensure that coders are able to secure a place for themselves in the coming years of the ICD-10 transition.

Tuesday, October 25, 2011

What You Need To Know About ICD-10 Translators

It is abundantly clear that failing to comply with the ICD-10 mandate will bring about severe consequences, for both an organization’s finances and efficiency. However, many healthcare payers and providers may be overlooking a key element that will ensure they incur less financial loss: the role of ICD-10 translators.

The challenge is not for healthcare organizations to merely achieve compliance, but to empower themselves by translating their legacy data to be compliant with ICD-10. While this may seem like obvious advice, the stress placed on coders to ensure that payment is received for new claims can overshadow the need to convert legacy data. In order to facilitate various analyses, claims re-submission or past claims adjudication this legacy data must be converted.

There is no automatic or direct translation from ICD-9 to ICD-10. The granularity of the ICD-10 coding scheme brings about many issues when transferring legacy system codes to the new code set. While payers and providers may like the idea of simply translating legacy patient and claims information into the applicable ICD-10 code using automated tools, these tools try to find the associated ICD-10 codes based upon the compounded specifications of previous ICD-9 codes. This can lead to unspecified data and information that the code designer never intended.

The key factor that impedes code translation is the sheer volume of possibilities that ICD-10 presents when compared to ICD-9. ICD-10 has eight times as many codes as compared to ICD-9. The ICD-9 code structure allowed only numeric codes with the possible inclusion of an E or V in front of the code for further distinction. Because of the limitations of the original structure, ICD-9 is reaching its capacity. The ICD-10 coding structure is alphanumeric, allowing for reporting while also allowing for the creation of new codes as needed, yet also making direct translation extremely difficult.

Truth #3
Translators cannot be 100% correct because there are very few direct translations from ICD-9 to ICD-10. To succeed, intervention by a skilled medical coder is mandatory.

Tuesday, October 18, 2011

HIMSS Webinar Discusses Cost of Non-Compliance

If you weren’t able to participate in HIMSS’ webinar, you missed a very valuable discussion. In addition to providing excellent coverage of a range of ICD-10 migration issues, the presenters also delivered some shocking statistics regarding the cost of non-compliance, particularly the cost of claims that are improperly coded and thus drop into the dreaded Unspecified Code category.  In the early years of the ICD-10 world, the cost of non-compliance will be at the highest point and the negative effect on cash flow from failed claims could be in the billions.  The study results presented by HIMSS ranked the expected causes of failed claims, and heading the list were coding errors on the part of the physician community, who are projected to account for 47 percent of all failures. Following behind physicians are payer systems that are not ready, compromising 15 percent, medical coder errors at 12 percent, shifts in DRGs making up 11 percent, delays in billing making up 7 percent and the remaining 5 percent from technology that is not ready. While all these problems can be resolved with time and expertise, the clock continues to run down for healthcare organizations.

Thursday, October 13, 2011

The Four Essential Steps in ICD-10 Testing

The consequences of failing to comply with the ICD-10 transition mandate will bring about serious consequences for healthcare organizations-both payers and providers. With the potential loss of revenue, efficiency and customer satisfaction arising from a backlog of suspended and unpaid claims, the importance of testing as the key means of assessing conversion readiness cannot be overstated.

In order to have a successful go-live and to be compliant with the ICD-10 requirements, each organization will have to navigate their way through these four essential steps:

1.     Test Planning: Understanding the scope and setting the precedence for each element in Unit Test and UAT (Unified Application Test).  Since there is a logical and step-by-step flow of business processes, from beginning to end, it follows that the test plan must mirror the business.

2.     Testing Protocol: How the tests for both logic and business process will be performed is the most critical step.  In advance, the test team must develop each step-by-step test case AND define each expected result. Test cases must be defined for conditions that will pass as well as those that will fail.

3.     Remediation: Prioritizing and remediating the unexpected errors identified during testing and, where necessary, adding test cases to the protocol.  Prior to completion of this step, all test cases must be re-run until the overall results conform to the test plan.

4.     Readiness Assessment and Turnover: Reviewing and documenting that the applications and business processes are deemed compliant with the test plan and thus ready to be turned over for production.

Because the amount of testing required is significant, many organizations will follow a process that tests the codes most necessary to an organization’s early success, e.g. enrollment. Once vital codes have been tested, the project team can move on to test code for more specific use cases.

IT professionals within healthcare organizations will be under a great deal of pressure to deliver an ICD-10 compliant environment. Test teams that can ensure providers receive payment on time will be extremely valuable assets to any organization as they will also be responsible for transferring knowledge to others.

Testing for the transition to ICD-10 and all of its ancillary parts may seem like the final step in the grand scheme of the transition but the value of planning for this phase early on should not be underestimated.

Truth #2
The only effective protocol for testing is to perform it until the results fully meet the criteria of the test plan.

Thursday, October 6, 2011

What are your CSF’s for managing your ICD-10 world?

The advent of a new world that comprises 5010 and ICD-10 bring with it the opportunity to evaluate the success of your business in new ways.  How should you view the opportunity to use new or different Critical Success Factors?  Watch for a future UppDate newsletter on this topic.

Thursday, September 29, 2011

Timeline Widget Available to Help Keep ICD-10 Transition On Track

Provided by the CMS, this widget allows you to track important dates along the timeline from the perspective of vendors, payers, large and small providers. You can also download the full timeline in PDF format.

Click the link below to visit the widget, powered by browserspring.