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Dennis Winkler

Sidney Hebert

The countdown is on.

With less than a year to go before the scheduled implementation of ICD-10, healthcare industry chatter about the new code set is reaching a fever pitch. Because ICD-10 is about overall system readiness, the discussion focuses mostly on how to get ready, what barriers to overall readiness exist, and what the industry can do to remove those barriers. Problems will inevitably arise if only part of the industry is ready and other parts aren’t.

With that in mind, certain groups are already hard at work to identify ways to make the transition easier for providers that are finding it difficult to get started. One such group is a newly formed consortium featuring Blue Cross Blue Shield of Michigan, Humana, and several other payors that are working together on strategies to help smaller providers get ready.

The consortium’s short-term plan is simple: meet with healthcare provider specialty groups (such as cardiology, dermatology, etc.) to help them focus on ICD-9 codes that each specialty group submits most often, then learn the Centers for Medicare & Medicaid Services (CMS)-approved ICD-10 translations for those codes. By starting with a specialty, it is easy to narrow down a list of the most commonly submitted diagnosis codes.

The transition can become much more manageable when specialized healthcare providers can concentrate closely on the diagnosis codes they need to use in order to conduct business. The remainder of the code translation efforts can occur at a later date. 

“The framework helps specialties understand how they can map their current ICD-9 codes to the corresponding codes in ICD-10 so they can focus their preparedness activities on their particular book of business,” said Dennis Winkler, technical program director of program management and ICD-10 for Blue Cross Blue Shield of Michigan. 

Once the healthcare providers have the code lists, they find themselves in a position to test their knowledge of those codes. This can be done through the use of several content-based testing environments popping up throughout the country.  These environments give the healthcare providers an opportunity to test their ICD-10 knowledge against pre-defined medical scenarios. The test results gauge the accuracy of the coding and the fee schedule reimbursement. 

“The consortium approach is in response to concerns raised in testimony on Capitol Hill at recent NCVHS hearings that payors may not be able to test with a large number of providers,” said Sid Hebert, director of the ICD-10 implementation team at Humana. “This approach allows for interested providers to evaluate their coding proficiency with real-world examples, keyed to specialties, through a dynamic interchange with cooperating payers.”

The consortium is working through the details of this strategy and plans to run a small medical specialty pilot for healthcare providers in Michigan. Based on the results and feedback received from that pilot, the payers will take the lessons learned and make any changes needed before rolling it out to multiple specialty organizations.

Once they finalize the information, they will share it with others and publish press releases and marketing materials. The consortium also hopes to take the framework and make it available to other states in an effort to make ICD-10 readiness among smaller providers a major focus in 2015.

 “ICD-10 is good for the industry,” Winkler said, “and it is in everyone’s best interest to work together and ensure readiness across the board.”

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Mark Spivey is a national correspondent for ICD10monitor

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