Looking back and ahead at ICD-10, ICD-11: Part III

EDITOR’S NOTE: Five Looking at Ten is a month-long series on ICD10monitor and Talk Ten Tuesdays that examines lessons learned since the nation’s healthcare system adopted ICD-10 – many of which are expected to come into play with the looming transition to ICD-11. Stanley Nachimson of Nachimson Advisors appeared as a special guest on a recent edition of Talk Ten Tuesdays focused on this topic, and this article is a summary of his remarks.

As complicated as the process was for the American healthcare industry to make its way from the ICD-9 coding classification system to ICD-10, it can still be summarized as finding away from Point A to Point B.

Stanley Nachimson helped craft the road map that laid out the route. 

“WEDI (the Workgroup for Electronic Data Interchange) recognized that ICD-10 was a major project for the entire industry and that the industry really needed some guidance as to exactly what to do, and when to do it,” Nachimson recalled. “So what we did is develop a broad, industry-wide project plan, using some software, and … published it. And what that plan showed were the necessary steps that entities needed to take, whether you were a vendor, a clearinghouse, health plan, or a healthcare provider; the dates by which those steps needed to be started or ended; and the tendencies among the different steps and the different actors within the industry.”

“We told folks when they needed to start their analysis of the rules and what ICD-10 was all about, when they needed to do their training, when development needed to be done, when the implementation within (each) organization had to be started and stopped, and when the testing had to be started and stopped, so that everyone would be ready by the regulatory date,” he added. “Of course, that date kept moving, so we adjusted the work plan for that, but it was an industry-wide work plan that anyone in the industry could download and follow, to be able to make sure they were able to meet the required regulatory implementation date.”

Nachimson served as director of what was titled the North Carolina Healthcare Information and Communications Alliance (NCHICA)-WEDI Timeline Initiative, bringing 30 years of experience with the U.S. Department of Health and Human Services (HHS) to the table – as well as a track record of developing federal policies and regulations.

“One of the other places I participated in with WEDI was as the chair of their testing workgroup; there we recognized the need for significant end-to-end testing … (and) that folks had to work together – from the provider through the clearinghouse through the health plan and back the other way – to ensure that everyone’s ICD-10 processes were correct,” Nachimson said. “We needed to make sure that claims and other transactions processed correctly, come the implementation date so that providers would continue to be paid appropriately. That end-to-end testing was really a key in making sure that everything worked correctly.”

ICD-11 implementation is already on the horizon, and Nachimson echoed other industry experts in suggesting that the lessons learned during ICD-10 implementation will continue to serve all the key players well.  

“I think for any industry-wide implementation, what we recognized was one, that vendors are really a key part of the industry, and their work needed to be done first before their products could be implemented at the plans and the providers,” he said. “So the vendors had to start getting their products ready, do their necessary testing, and then turn it over to the industry, where plans, providers, and others could then start implementation and testing. It’s a multi-step process, with the vendors leading the way.”

“The second item that I think we really understood was the interdependencies among vendors, plans, and providers: that everybody had to work together, they had to be aware of the steps that each (entity) was taking, they had to communicate with each other, and especially, match up in terms of testing,” Nachimson added. “So when providers were ready, they had to find a plan to test with, and when plans were ready, they had to find providers to test with, and when the vendors were ready, they had to make sure their customers were ready to do their implementation. It was really fascinating to see how the industry really had to work together in order to accomplish this major effort. And I think we’ve seen that in the follow-ups when we talk about implementing electronic health records, and any other major changes in the healthcare industry.”


Mark Spivey

Mark Spivey is a national correspondent for RACmonitor.com, ICD10monitor.com, and Auditor Monitor who has been writing and editing material about the federal oversight of American healthcare for more than a decade.

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