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 Thought Leaders

Transitioning to ICD-10

What your RCM and clearinghouse vendors should be doing to help you now.

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   By Ken Edwards, Vice President of Operations, ZirMed, April 2014

Ken Edwards, Vice President of Operations, ZirMedA common theme in recent articles and presentations about ICD-10 is that many providers are not ready for the transition, and that lack of action now could spell disaster later. With this critical change on the horizon, it is important to state that provider organizations don’t need dire warnings. They need plans of action.

Your revenue cycle manager (RCM) or clearinghouse vendor should be proactively engaged and contacting you. They have more time right now than they will in the months following Oct. 1, so they should want to help you find and fix problems now. If they’re reaching out now, that’s a good sign. Talk to them.

When they contact you, they should provide an ICD-10 readiness assessment and they should enthusiastically encourage you to complete it. Vendors that do not provide a readiness assessment and automatically collect the results, or that seem indifferent about completing the assessment, are either not prepared to assist you or they are not interested in understanding what kind of help you need. If they truly want to help you make a successful transition to ICD-10, they will be very interested in the results of the readiness assessment because it is the best tool to develop a clear sense of where you stand. If they want to determine that status, it means they’re making decisions about the best ways to support you, not simply counting on a catch-all approach.

Remember, clearinghouses are perfectly positioned to help you to focus your ICD-10 testing efforts, and they’ve had well over a year to prepare. They should be ready to provide a list of your top payers and a breakdown of your code usage. If they’re truly prepared, they will volunteer this information. If you request it and you have to wait a week before receiving it, they are probably scrambling to pull it together and, to make matters worse, they may already be backlogged with work from their other clients.

A logical step would be to focus testing on your top-10 payers. Your vendor should be prepared for this request. Not all payers are offering end-to-end testing, but your vendor should know whether your payers do, and provide you with a way to stay up to date on their testing status.

Your vendor should also look for ways to help you test, not for reasons why you are not ready or not eligible. For example, if your system cannot yet produce ICD-10 claims, they should be prepared for that, and to offer you an appropriate workaround.

Engaged, prepared vendors will not just be willing to help you test. They will truly want to help you test, because the process benefits them as well. The more a vendor tests with payers, the more feedback they’ll have from payers, and the better their rules and edits will be by Oct. 1. That level of preparation will mean cleaner claims and fewer rejections.

If your vendor is on top of their game, they are already finding multiple ways to help to identify risks and to root out potential problems on your behalf. For example, they will already have identified which clients and which payers had the greatest difficulties during the 5010 transition. They will also have cross-referenced these lists looking for high-risk pairings. Engaged vendors will diligently reach out to these two groups leading up to the ICD-10 transition. Although providers’ and payers’ 5010 experience isn’t necessarily a perfect predictor of their ICD-10 readiness, it’s one potential leading indicator, in the same way that not hearing from your RCM vendor raises questions about how prepared they are to help you. That’s the key: knowing what signals to look for and investigating what’s behind them.

If you don’t understand your sources of risk as we get closer to Oct. 1, you can’t take the necessary steps to eliminate or minimize them. Following the approach outlined above will help you expose ICD-10-related risks to your revenue cycle. 

It’s a plan you can act on – not another warning about what will happen if you don’t.


Tags:  Thought Leaders  Revenue Cycle Management  ICD-10