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ICD-10 Collaboration: Reaching Out Across the Aisle

June 20, 2012
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Are payers and providers playing nice for ICD-10?

Much has been made of the payer-provider collaborative efforts that will have to take place over the next few years as the healthcare industry transforms with the various regulatory mandates from the American Recovery and Reinvestment Act/Health Information Technology for Economic and Clinical Health Act (ARRA/HITECH) and the Affordable Care Act (ACA). In my opinion, nowhere is the need for payers and providers to be on the same page more apparent than with the ICD-10 transition.

As someone who covers primarily one side of the equation, it’s sometimes easy to forget that payers are tied to the ICD-10 transition just as much, if not more, than providers.  After all, this is a coding change we’re talking about, and the ones processing these codes are the payers. Just like it is for providers, changing from the ICD-9 code-set and its approximately 14,000 codes to ICD-10 and its approximately 69,000 codes, is a huge undertaking from the payer side.

I recently picked the brain of Sharon Perkins, director of information systems at the small Texas-based HMO, El Paso First Health Plan, to discuss the ICD-10 transition from the payer side. When talking about the task of switching over to ICD-10, one theme that kept coming up was working with providers in terms of preparedness.

“The other step [for the ICD-10 transition] is that our provider relations department makes sure our provider partners that work with our customers are prepared as well. They are charged with partnering with them, letting them know what time frame we are working on, and making sure we are on par so there is no service interruption as a result of their systems not being prepared,” Perkins told me. El Paso has a call center that not only takes inquiries from members, but from providers as well.

In the broad perspective of an ICD-10 transition, Perkins said that making sure various intricacies are taken care of so that the provider’s care to the end-user is seamless is important. Clearly, this means working with the provider every step of the way. Many advocates from the payer community, such as Ian C. Bonnet, VP of ICD-10 adoption at the Indianapolis-based WellPoint, have stressed this point often. For instance, back at HIMSS12 in Las Vegas, at a presentation on payer-provider collaboration, he talked about how insulating (transforming claim-level data) from ICD-10 fails mainly because of a lack of supporting clinical information.

In our talk, Perkins even told me that the ICD-10 compliance delay was a good thing because it will used to slow down some of El Paso’s training sessions, including the ones with the providers’ relations team.  These training sessions are essential, she said, because providers’ relations are the ones communicating the changes to their provider network. I’ve actually heard this from payers, providers, as well as consultants.

As the ICD-10 transition becomes mission-critical for the payers, it will be interesting to see how many keep an extensive level of communications with their providers.  If there are any payers that aren’t yet preparing to collaborate with providers; that obviously has to change.

I’m curious if any of our readers have any experiences, on either the provider or payer side, about collaborating with the other side on the ICD-10 transition?

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