Well, that’s where the provider community finds itself right now. I have been talking to quite a few providers (large and small, specialized and generic) and eventually I have formulated an opinion (You will never find me short of opinions). The hypothesis goes such…
Continue reading "Ever heard of getting caught between a rock and a hard place…" »
CMS has used the opportunity brought in by the increased specificity of ICD-10 codes to increase the granularity of DRG codes. This will help CMS streamline Medicare payments. Since significant number of Medicare and commercial claims is paid based on DRG codes, the added granularity is bound to cause uncertainty around provider reimbursements. This uncertainty combined with the payment reductions under SGR (Sustainable Growth Rate) has the potential to significantly impact providers’ bottom-line. Payers are not immune to the impact either. It’s crucial that payers and providers simulate claim payments, compare the payouts between I9 and I10, and be better prepared for the change.
Continue reading "ICD 10 – uncertainty around provider reimbursement" »
The necessity for dual processing with ICD-10 is not just a result of interoperability between entities on disparate code-sets. Even if we assume that all the payers and providers are migrating to ICD-10 (desirable, but hardly a pragmatic situation) on Oct 1st, 2013 (compliance date), dual processing is going to be required for some adjusted claims and inpatient claims.
Few weeks ago, in one of my blogs, I had attempted to set some basic tenets for the tactical option (downgrade-store-and-forward) for complying with the 5010 mandate. They primarily covered,
• A dynamic rules based bidirectional converter
• A comprehensive store-and-forward mechanism for storing and retrieving reduced data
• A clear performance management strategy to manage data reduction (for down conversion) and data addition (for up conversion)
• A robust API to provide access to reduced data for the downstream applications, and
• A comprehensive test bed and associated test strategy
I promised in that blog that I would not ignore the strategic approach (remediating downstream applications to make full use of the mandate) and would tackle that in a future blog. So here we are. Lets see what are the basic tenets for the strategic approach.
Bad news first… HIPAA 5010 has nearly 1,000 unique changes. Some of these changes (like expansion of patient last name alone) could have thousands of impact points across your applications and databases. Overall, the number of impact points could easily run into a couple hundred thousand for an organization of average size. The direct and indirect impact of these 1,000 changes on the IT systems needs to be analyzed as the first step in the 5010 transition journey.
Continue reading "HIPAA 5010 transition – building a case for automation" »
Provider contracts (among other things) are written using ICD and DRG codes. As a result of the increase in number of codes in ICD-10, a new set of DRG’s will have to be created – to take advantage of the increased granularity of information for payments. Eventually every provider and payer will move to contracts based on ICD-10 and related DRG codes. But the switch will not take place overnight. There will be a transition period, during which contracts will be gradually migrated to ICD-10 world. It is this period that will require dual storage and processing of data.
Every place I go these days and ask people the question if they are ready for 5010, the answer that I get is ‘Yes, absolutely’ and then invariably 20 minutes into the conversation it transpires that ‘No, not really’. Most everybody seems to have missed out one or two, and in some cases quite a lot more, crucial components of the overall transition. And it does not matter whether people are opting for tactical (downgrade to 4010 and proceed) or strategic (full remediation) approach.
That made me think; wouldn’t it be a good idea to create an illustrative checklist for things that one must take care of to ensure smooth transition? So, given the fact that once I start thinking on a particular line, I invariably become obsessed about it and must get it out of my system (mostly at the expense of readers), here is an attempt at a very high level checklist for the tactical approach. Will cover the mandatory requirements for the strategic approach in the next blog.
Business transformation by definition is an initiative to align People, Process and Technology initiatives to the company’s strategy, vision and long term objectives, with defined outcomes such as 30% reduction in operational costs or 70% increase in customer satisfaction.
Continue reading "ICD 10 – a solid case for business transformation" »
Not too many organizations seem to be unduly concerned about the impending conversion which is now less than two and a half year away for 5010. Or so it seems at least by the actions being taken in the industry. Though I have been hearing a lot about how worried they are regarding the lack of time they might have for changing such a complex network of application portfolio, but not many seem to be taking actions commiserate with their concerns.
We have seen quite a lot of semi-structured exercises taking place, either using internal staff or leveraging high-end consulting organizations but they are primarily limited to very high level analysis of what is going to be impacted. While the initial high level assessment is not a bad idea at all, in my opinion we should be way past that stage by now. A seventy page power-point deck highlighting the twenty core areas that are going to be impacted would have been a good idea in March’2009 but may not be sufficient in October’2009.
Continue reading "What is going on with 5010 and ICD10… I guess not much" »
Is there too less time for ICD-10 transition? Or is there plenty of time? Will my vendor ensure that we’re compliant, or should we engage a consultant to do a thorough gap assessment? These are questions that should be and probably are on every program manager’s mind that’s been entrusted with the ICD-10 implementation in his organization.
Continue reading "ICD-10 – so what are the ideal timelines?" »
Cheapest option to compliance – who wouldn’t be interested? Especially in an industry that potentially spends more than a quarter trillion dollars per year on regulations. In the case of HIPAA 5010, developing just the ability to send and receive 5010 transactions will achieve basic compliance and is arguably the cheapest option. I wouldn’t be too hasty to call the organizations that plan for basic compliance as short-sighted, but at the same time I’d recommend that organizations at the very least perform an assessment before heading that path.
Continue reading "HIPAA 5010 – Tactical vs. Strategic Implementation" »
The implementation of ICD-10 will be daunting to say the least. Estimates regarding what this will take to implement are anywhere from 12,029M – 30,480M; with the bulk of the cost needed for system upgrades, conversion and crosswalks. A simple question to this massive undertaking is what the return will be to the health care industry and likewise for everyone who participates in the health care system.
Continue reading "Implementing ICD-10: How It Can Help to Reduce Cost and Improve Quality" »
Enough has been said and written (some in our own blogs here) about how HIPAA 5010 should be seen as “business transformation”. It’s okay to view it as a transformational program as long as you have the extra money and the time to implement one. If you don’t have either or only one of the two, I’d say stay focused on to the compliance aspect and what I like to call the “tactical opportunities” or the low hanging fruit.
In the ICD-9 era, the ICD Codes were small in number, though not highly organized as ICD-10 is. Given that the ICD-10 codes bring in the granularity and accuracy to the diagnostic and procedure coding, not to mention decades of familiarity of the coders in ICD-9, how does a provider ensure that these codes are coded correctly?
As US Healthcare industry races to comply with HIPAA 5010 and ICD10 regulations by Jan’2012 and Oct’2013, these two changes remain as the biggest challenges the US healthcare industry has faced in decades. Processes and IT systems will need to be remediated and people retrained to ensure business continuity and avoid penalties. These two changes are being termed as the “Y2K of the healthcare industry” and are expected to cost the industry close to USD 20 billion for remediation.
Continue reading "Business Transformation Catalyzed by ICD-10 and HIPAA 5010" »
Few industry experts have called ICD 10 “the Y2K of the healthcare industry” and some organizations are taking it too literally – and they couldn’t be more wrong. In my view, the only thing that these two changes have in common is “the extent of their impact on the enterprise landscape”, and the similarity pretty much ends there.
Continue reading "ICD 10 is the Y2K of the healthcare industry – really?" »
I wish experts gave HIPAA 5010 the credit it deserves as an independent endeavor to improve EDI and reduce cost of healthcare. Positioning HIPAA 5010 mainly as the “pre-requisite” for ICD 10 is turning organizations’ focus away from implementing 5010 as an improvement measure.
Continue reading "HIPAA 5010 – more than just the pre-requisite for ICD 10!" »
Isn’t that the million dollar question? A very wise man once said that for one to be ready to tackle an issue, one first has to acknowledge that there is an issue. Furthermore, one has to consider the issue as a clear and present impact/danger to one’s current state of existence, be it financial, physical or mental.
Continue reading "ICD10 transition – Are the providers ready?" »
HIPAA 5010 and ICD 10 are impacting the healthcare industry in an unprecedented way. The scale of the impact to systems and processes is such that there is no scope for debate on the need for upfront risk management strategies. However, I think the need for a distinct pilot phase as part of the risk mitigation strategy is debatable.
Continue reading "HIPAA 5010 Transition – is a distinct “pilot” phase necessary?" »
As with anyone, physicians and other healthcare providers see paperwork as more of a burden on them than anything else. While there is no doubt that ICD-10 is going to improve the quality and efficiency of overall healthcare delivery and administration, it is going to increase the burden of paperwork even further. I think there is an urgent need for investment to address providers’ concerns around paperwork, especially with ICD-10 due for implementation in a few years.
Continue reading "ICD-10 – How to deal with the increase in paperwork?" »
So, here we are, in early 2009, worried out of our wits regarding an event that is supposed to take place towards the end of 2013. Any other industry, any other event (with due reverence to the Y2K paranoia) and we would have been calling the alert-raisers as nothing more than rabble-rousers, worse yet, fear mongers. But not with ICD10 transition. No name calling here. In fact the worried lot is definitely in majority this time around.
Continue reading "ICD10 transition – Potential Healthcare Meltdown? I think not." »
