The delay was one of several delays the government has announced over the years that affect ICD-10 and other administrative simplification regulations as well. “Each of the delays cost the industry money,” said Joe Miller, director e-business, Amerihealth Mercy, a commercial plan. Miller ticked off a list of regulatory driven projects delayed over the years, including 4010, 5010, and the national payer identifier standard. “This is not good for the industry,” he moaned. “The intended benefits of the regulations are postpone and it undermines confidence in the regulatory process.”
Miller is participating on a joint effort between HIMSS and WEDI to smooth the transition to ICD-10—and to help avoid another delay (the first delay was called for by several industry trade groups, citing lack of provider readiness for the new code set, which drives industry billing). The HIMSS-WEDI group is developing a set of standardized testing scenarios for both group practices and hospitals submitting their retrospective professional services and institutional claims. The scenarios describe common clinical conditions and are intended to help guide a test claim from provider to payer. Jim Daley, long-time ICD-10 and administrative simplification activist, said the hope is to have some common testing scenarios so the industry can build best practices and see where the pitfalls are in moving to ICD-10.
Miller said that health plans have a vested interest in a smooth transition to ICD-10. Many have raised the specter of ill-prepared claims trading partners leading to a bevy of denied claims. “The last thing a payer wants to do is issue denials,” Miller said. “If we have to process a claim twice, it costs us more money.”