ICD-10 conversion: Partners help healthcare clients prep

Technology and service providers are helping their healthcare customers prepare for the looming ICD-10 code conversion deadline.

Whether healthcare firms are ready or not, the U.S. government’s upcoming deadline for ICD-9 to ICD-10 conversion stands firm. On Oct. 1, 2015, healthcare providers must submit all of their claims using ICD-10 codes. With no grace period, technology and service providers are preparing their clients for the transition any way they can.

ICD-10 expands the number of claims codes from around 17,000 to more than 140,000. “The whole purpose is to get to a more granular level. That’s why there are so many new codes with ICD-10,” said Crystal Ewing, senior business analyst and manager of regulatory strategies for ZirMed Inc, a provider of cloud-based financial and clinical performance management offerings for healthcare based in Louisville, Ky.

Conversion to ICD-10 begins with system upgrades. “Making sure the billing or EMR [electronic medical records] system is compliant — that’s the first key,” Ewing said.

But that isn’t where the difficulty lies: “The challenge is more in terms of practitioners wrapping their heads around the new code set. Because the transition will happen all at once, it’s difficult to predict how it’s going to impact their practice and workloads,” said Elysha Fiabane, product innovation manager and overall ICD-10 project lead for athenahealth Inc. The company, based in Watertown, Mass., provides cloud-based services for electronic health records and other healthcare applications.

“This is not just an IT problem. This is more of a business problem. Look at it this way: The system can ingest the data, but the data has to be good. The data has to be quality,” Ewing said.

She explained: The diagnosis must match the ICD procedure code, and the code must be verified and appropriately documented and billed. “There’s an intervention that has to happen there, and there can be many business processes that have to change to make sure that can happen,” Ewing said.

Helping coders face ICD-10 transition impact

Coders and those who bill medical claims will be most impacted. “They’ve been using ICD-9 for 30 years, and most of them have the codes memorized. ICD-10 is completely new, so ZirMed provides tools to help them understand what they do today and what the impact will be tomorrow,” Ewing said.

This is not just an IT problem. This is more of a business problem. Crystal Ewing senior business analyst and manager of regulatory strategies, ZirMed Inc.
For example, ZirMed’s analytics platform helps healthcare providers understand the payers to whom they submit the most claims and the codes they use. Ewing said this allows providers to “build critical benchmarks to understand what they’re doing today so they can identify if there’s going to be a problem tomorrow.”

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