Panelist Joanne Romasko is director of medical economics for Blue Cross and Blue Shield of Montana, the largest payer in the state with more than 300,000 covered lives. Romasko said getting the plan ready for ICD-10 is both a technical and a human relations challenge.
Some plans, Romasko confirmed, are talking about strategies of accepting claims in ICD-10, but converting them to ICD-9 for payment.
“We don't want to continue with ICD-10,” Romasko said, so the Montana Blues plan has “taken a stand.” When the Oct. 1, 2013 compliance deadline arrives, “if it's not in ICD-10, the claim will be denied,” she said.
Vendor readiness, just as it is for providers, is a concern for the Blues plan, since it has about 120 vendors and “more interfaces than even that number,” she said. But Romasko said the biggest worry is provider readiness—or a perceived lack thereof. Providers are not focused on ICD-10, she said. “We're worried about what a denied claims status might do to them.”
Rebecca DeGrosky, project manager for TrueCode, a developer of coding software, told the audience comprised mainly of provider organization workers, that her company's focus is on employee training. “But unlike you, I don't have to train coders. I'm training developers and folks who support software.” They have to be trained in ICD-10 to understand its impact on product usability “to understand how we can build the program that we want it to be.”
Also, “vendors need to make sure adding ICD-10 doesn't break something,” she said. Right now, providers need to be asking a lot of questions of their vendors, what their plans are, whether their products will accommodate coding in both ICD-9 and ICD-10, whether there will be transitional products and whether any interfaces they have now will work with ICD-10 upgraded products?
“Don't assume anything from your vendor,” she said.
Keith Olenik, a consultant who most recently served as interim system director at Cook County Health & Hospitals System in Chicago, said ICD-10 at the three-hospital system has taken a back seat to preparations to meet meaningful-use targets under the federal EHR incentive payment program by 2012.
Some work has been done on ICD-10 planning, however.
“We have a preliminary list of systems that have been identified,” Olenik said.
According to Olenik, because it is publicly funded and has a patient mix that's about 60% self-pay—which leads to a considerable amount of charity care—billing and revenue cycle management have not been key issues.
“We've not been doing a good job of reimbursement and coding,” he said. Cook County will probably need to add coders to cope with the ICD-10 shift, he said, while, “figuring out the skill mix and the requirements for all these people is going to be a challenge.” Early physician training also will be a key issue as well, since physicians on staff are hospital employees, he said.
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