Don’t Sleep on ICD-10 Testing

RCM Answers | May 11, 2015

The value of ICD-10 testing is deeper than confirming that your software is up-to-date and your vendors are tuned in and ready to support you throughout the transition. Testing is a time-sensitive training and learning opportunity for you, your vendors, and your payers—invaluable for key front-line staff in particular.

For back-office administrators and staff, testing is a chance to examine existing claims management processes with fresh eyes—it’s an opportunity for deliberate, structured reflection among teams whose day-to-day is likely fast-paced and non-stop.

As a leader, it’s also an initiative that you know will pay off—because it directly supports your ability to execute when the financial and operational impact of ICD-10 become real as opposed to imagined and subject to ongoing anticipatory doomsday hyperbole. Yet the fact that the stakes are lower before go-live should not lead you to lose sight of the urgency nor the true goals—figuring out what isn’t working, perfecting new processes to preempt those errors moving forward, and ferreting out imperfections that create bottlenecks or otherwise limit efficiency.

Defining—and then adding—long-term value.

Regardless of whether ICD-10 ends up being delayed yet again—which many industry experts say appears increasingly unlikely—a culture of collaboration among your staff, vendors, and payers will pay off for years to come. As public and commercial payers continue to accelerate their shift toward value-based and accountable-care models, it will be necessary to test, analyze, and optimize new functionality and new processes that support these still-developing models. In fact, that might be a hallmark of the shift toward value-based care: fundamental and potentially disruptive change that requires collaboration and collaborative testing.

Framing ICD-10 in the context of other major shifts in healthcare can help you transcend any past disagreement or debate. And reframing the value of ICD-10 testing creates something of a blank slate for those who opposed—or still oppose—moving to ICD-10. It frees them from concerns driven by ego or self-consciousness, making it easier for them to commit and participate in testing and training without feeling like they “gave in” or “switched sides.”

Leveraging clinical and financial arguments for ICD-10.

ICD-10 will provide additional and more granular detail about chronic diseases, comorbid conditions, disease-management best practices, and mental health care—just to name a few top-of-mind examples. In aggregate this detail will become a rich source of insight for evidence-based medicine and also has the potential to accelerate the research process since historical data (both coding and clinical documentation) will become more comprehensive and specific. The data will underpin newfound abilities to manage population health, as it will enable informed, accurate segmentation of patients within existing disease registries or among previously indistinguishable subsets of patients.

Other examples in this same vein might include:

PQRS:
In many cases, the details needed to support PQRS reporting are also needed to support ICD-10 coding. Are you reporting on smoking status and cessation for PQRS? You’ll also need to record smoking status to avoid ending up with an unspecified code under ICD-10. Or let’s say you’re reporting on Measure #117 – Diabetes: Eye Exam. For any diabetic patient who becomes pregnant, you’ll need to record the trimester in which the eye exam takes place—and under ICD-10, you’ll also need to record trimester for nearly every type of encounter with every pregnant patient.

Population Health Management:
Fee-for-service isn’t going away, but as fee-for-value rises, identifying and addressing gaps in care (along with other aspects of population health management) will have greater and greater ability to impact your overall clinical and financial performance.

Fee-for-value requires clinical integration and comprehensive longitudinal records of care. The quality of those records starts with the granularity and quality of your documentation—aka the same foundation for coding accurately in ICD-10. Whether you’re striving to meet specific quality measures for a state incentive program, or taking on new risk-bearing contracts with payers, documentation will play a significant role in how successful you are under fee-for-value models. Among other things, it will determine how wisely you expend case manager hours and other care intervention resources.

It’s OK to state it plainly—and sometimes it’s necessary.

Claims rejections and denials are frustrating for everyone. They create backlogs, delay revenue, and drive up costs by forcing re-work and appeals. If the backlog becomes unmanageable, inability to meet timely filing requirements results in either lost revenue or long hours and extra stress for back-office staff.

ICD-10 testing is an organizational and industry imperative. Leaders must do whatever it takes (within reason—I’m not suggesting locking all the doors until testing is complete) to make it happen and make it worthwhile rather than a pro forma exercise. That means being a relentless advocate for its value and a nimble articulator of its benefits. In some cases it means going to the mat for the resources necessary to jump-start testing with vendors and payers—and in all cases it means ensuring results are thoroughly analyzed and insights are diligently acted upon. It means refusing to let your commitment waver, and refusing to let anyone’s lack of commitment derail the overall initiative.

I’m not saying it’s all on you, because it’s not.

It’s on all of us.

About the Author

— Ken Edwards is vice president of operations at ZirMed, specializing in operations management and leadership.

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