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Rocky ICD-10 rollout predicted for Oct. 1 deadline



Chaos is the predicted descriptor of the Oct. 1 deadline for nationwide conversion to the ICD-10 codes, according to one healthcare information technology professional. But Dr. Terrance Govender, Navigant Consulting's director of healthcare coding and documentation, says providers can still take steps over the next six months to mitigate some of the disruption.

The CMS will be the most likely mitigator of that disruption, Govender predicts, even though, for now, the agency is talking tough.

CMS Administrator Marilyn Tavenner said recently in no uncertain terms that the agency will not budge on the Oct. 1 start date for ICD-10. Tavenner isn't bluffing, but being strategic and not showing all her cards, Govender said.

“I think a lot is going to depend on the level of disruption we have once we do go live with ICD-10,” he said. “I believe that if they put out any kind of energy that there is going to be a back-up plan, then folks will revert to human nature and wait for the back-up plan.”

Meanwhile, this week, the CMS has authorized contractors processing Medicare claims to perform one-way testing with select providers submitting ICD-10 coded claims. The CMS also committed to conducting more robust “end-to-end” testing later this summer.

CMS testing, Govender said, is “absolutely necessary for both providers as well as third parties,” such as claims clearinghouses, to know whether the nation's largest healthcare payer and providers are prepared for ICD-10.

“I think it's going to be a very good indicator of where they are and where we are,” he said.

For providers, however, investing now in physician training on documentation with the more complex and granular ICD-10 codes is a key mitigation strategy, Govender said.

“I may be biased as a clinician, saying physicians are extremely important” in ICD-10 preparedness, Govender said. “I'm heavily involved in physician engagement. Getting physicians on board is one of the biggest challenges for ICD-10 implementation.”

“We've been pushing physicians for a long time to change documentation habits to support pay-for-performance,” he said. “Now, we have leverage with ICD-10 to get them to document, not only to support ICD-10, but also value-based healthcare.”

Another provider mitigation strategy is to improve external and internal organizational communication between health information technology systems vendors, internal IT departments, health information management staff and physicians.

“We need to break down the silos between those different groups,” Govender said, because they all must support each other. “We need to get physicians on board, make sure vendors and IT people are on board, make sure HIM (health information management) has a firm, dual-coding strategy in place. HIM needs to feed back to physicians what's working and what's lacking in their documentation for ICD-10.”

Even with these preparations, Govender remains skeptical about a smooth ICD-10 implementation on Oct. 1 .

“I think we'll do as best as we can, and do as much as we can, but this is going to be a paradigm shift for us, a change which most don't appreciate the magnitude of, and that's going to cause us to fall short,” he said.

Follow Joseph Conn on Twitter: @MHJConn

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