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ICD-10 Specialist on Impending Transition: “It’s a Process Change”

September 15, 2015
by Rajiv Leventhal
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Recently, the Centers for Medicare & Medicaid Services (CMS) announced a third successful round of week-long ICD-10 end-to-end testing, saying that it accepted 87 percent of submitted claims from the testing period of July 20 through 24. During the first ICD-10 end-to-end testing week, 81 percent of claims were accepted by CMS, while 88 percent of claims were accepted during round two.

While it might seem as if the successful end-to-end testing results would quell the healthcare industry’s angst over the ICD-10 transition, recent ICD-10 readiness surveys from the Workgroup for Electronic Data Interchange (WEDI) and from Duluth, Ga.-based Navicure revealed that levels of preparation and readiness for the transition are not high within healthcare organizations.

As such, there seems to be varying degrees of optimism for ICD-10 implementation as the industry awaits the Oct.1 deadline, now just a few weeks away. Physicians, in particular, are feeling the heat of another regulatory burden— a recent survey from the Texas Medical Association (TMA) found that just 10 percent of Texas physicians are confident that their practice is prepared to transition to the new coding set on Oct. 1.

Josh Berman, director, business analytics & ICD-10 lead at Relay Health (a part of the Alpharetta, Ga.-based McKesson Corporation's technology solutions segment) is heavily engaged with stakeholders of all sorts across the industry, having also previously worked for Cleveland Clinic where he focused on physician billing, Medicare compliance, EDI transactions, and payer negotiations. Berman recently spoke with Healthcare Informatics Senior Editor Rajiv Leventhal about what significance CMS’ testing results might have, what strategies organizations can deploy to continue to get ready, and what we could expect to see at the beginning of next month. Below are excerpts of that interview.  

What did you take from CMS’ end-to-end testing results?

I think my opinion might differ from most, as I never believed that testing was of high value, most because it’s a process change, not a technology change. When you’re doing a technology change, you can test; for a process change, it’s not that easy. CMS did a good job and did their due diligence, but people are equating that to readiness on both the provider and payer side, and that’s just not the case.

We probably tested the industry’s most claims, right around 200,000 claims. On average, our clients tested 90 claims, so that’s a big number.  But we process 55 million claims per month, so providers decided to send was a really small amount of the whole that they do every day. That’s fine when you’re testing a technology, but it’s not fine when you’re testing a process.

Josh Berman

What are you hearing regarding organizations’ readiness?

On Sept. 1, my phone started going crazy. It’s one of those magic calendar dates that people pay attention to. People are definitely scrambling. What I hope people finally get is that this is not about a payer if you’re a provider or vice versa; this is a process change about yourself. I’m not sure everyone has that locked in. If you made me pick, and this is based on testing results, it will be the ability of providers to get ICD-10 claims out their doors with the same speed and efficiency that they are doing with ICD-9. But if you talk to providers about what their biggest problems are, everyone will say that the payers will mess it up.

So what are the payers saying?

Payers are saying that they are ready. Many payers said that in 2012 that they updated their systems with new tables, they processed the claims that providers sent them, and sent those back based on what the providers sent. Payers have been saying this for a long time—that they are processing the claims quickly, but it’s on the providers to code correctly. Payers that have invested in testing like I would have if I were them—the good ones—did their testing and gave results back from the 50,000 foot view. And those results said that your coding is not right.

What will the impact of that be when Oct. 1 hits?