Problems with ICD-10 transitions are bound to occur for most healthcare organizations, and in these final hours before October 1, contingency plans should be reviewed and studied closely to ensure they cover potential problem areas.
A panel of providers versed in ICD-10 preparedness told Health Data Management editor Fred Bazzoli some of the ways they were preparing for problems. Anticipating payer issues were at the top of their list. The panel included:
- Aaron Miri, CIO at Walnut Hill Medical Center.
- Jean McCammack, Chief Quality Officer at Walnut Hill Medical Center.
- Debbie Schrubb, Corporate Director of Health Information Management and Kettering Physician Network Coding at Kettering Health Network.
- Stephen Stewart, Interim CIO at Schuylkill Health Systems in Pottsville, Pennsylvania.
Fred Bazzoli: What if there are problems with the transition? How do you implement your contingency plans? What are the major areas where you need solid contingencies?
Debbie Schrubb: I have to admit I don't know that we have solid contingency plans. My one fear right now is if we do extra coding support, it's not going to be enough. We've been talking about that one really seriously--most of the vendors out there are tapped out and they just don't even have people available for us.
We have a contingency plan put in place for cash on hand, because there is the fear that we may have some difficulty getting claims turned around as fast as we're used to. We’ve had those conversations with our payers. We're also looking at capital expenditures and maybe holding back on some of that for the rest of the year until we know what's going on.
It’s one of those situations where your best laid plans might not work out. So, we may have to make up some plans as we go along. I think we all feel comfortable that we're ready. But what happens if the payers aren't ready?
Stephen Stewart: I share that concern—well, not concern but interest-- about preparedness on the payer end. Our testing certainly indicates they're in pretty good shape. But I think payers are pretty much like we are in that they don’t have production-hardened processes.
So what's going to happen when ICD-10 claims are rolling in, and what is reimbursement going to look like? We code for specificity, and if that specificity supports lower reimbursement than what we we’re used to, what does that mean? Or, on the plus side, what if it's higher reimbursement than we’re used to? Some of those things are going to settle over time, but I’m watching it very, very closely.
Staying on top of denial rates is going to be a really big deal. It's kind of like doing disaster recovery planning or business continuity planning: What disaster do you prepare for? From an IT perspective, if the computer room goes up in smoke, we have a plan for that. But overall this is totally virgin territory. We haven't done this. We haven't had this.
When ICD-9 came in, it wasn't as computerized an environment as it is today. So I don't think any of us quite really know what could happen with ICD-10. Our mantra is have our very best resources available to make the very best response, because I'm not smart enough to anticipate everything that could go wrong. So I'd rather focus on what we hope goes right, and deal with the hand we get dealt.
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