Claims-processing standards and delays—when will they ever learn?

I was in our archives last week, doing research on the nationwide conversion to ASC X12 Version 5010 administrative claims standards, when I pulled up a story I had written late last summer about the status of 5010.

In that September article, Sunny Singh, the president and CEO of Edifecs, the claims-processing software developer, predicted we'd still be "scrambling" to comply with 5010 not only through the rest of 2011, "but also in Q1 and Q2" of 2012.

Singh's forecast was spot on. California scrambled through the last week of June to get its Medicaid program into 5010 compliance.

Nine percent of respondents to an MGMA-ACMPE member survey in mid-June said they still had little to no confidence that their practices were filing claims in accordance with the new 5010 standards.

Given his earlier prescience, I interviewed Singh again last week. I told him, using the powers vested in me as the health information technology reporter for Modern Healthcare, I was appointing him HHS secretary.

Then I asked him, "Mr. Secretary, what are you going to do to make future national standards upgrades and conversions—such as the upcoming adoption of the national plan identifier and the conversion to ICD-10—go more smoothly?" Here are a few of his recommendations:

• The CMS should test standards before publishing them for implementation. The CMS was fixing many coding issues found in production throughout the first quarter of this year, he said, and that contributed to HHS' delayed enforcement of its own 5010 rule until after June 30.
• There should be more coordination in the industry around collaborative end-to-end testing of upgraded systems. Singh recommended that "external" testing among providers, plans and clearinghouses occur in the preproduction cycle and be built into a formal implementation schedule.
• Upgrades to Health Insurance Portability and Accountability Act standards need to be performed more frequently. Seven years between Version 4010 and 5010 was "entirely too long," he said. With a more-frequent upgrade schedule, upgrades will become part of the routine, and that will reduce some of the issues that surfaced with 5010.

Can I get an "amen" on Singh's recommendations?

It takes a health IT historian to recount the genesis of our current ICD-9 family of procedural and diagnostic codes. ICD-9 was adopted in the U.S. in 1979. Its proposed successor, ICD-10, was released in 1990, but it's looking as if ICD-10 won't be adopted here until at least 2014. That would be just a year before ICD-11 is to be released. Everyone I've spoken with says the 5010 conversion will seem like a cakewalk compared with upgrading to ICD-10.

If the U.S. is ever to create a learning healthcare system, people who run it must put their hands on the levers of change and manipulate them far more adroitly than they have been able to do in the past.

The recent adoption of Version 5010 has provided valuable lessons on how to change. It remains to be seen how many healthcare leaders have learned anything from them.

Follow Joseph Conn on Twitter: @MHJConn.