Wednesday, August 22, 2012

7 Things Your ICD-10 Product or Service Vendor Should Share with You

If you’re organization must comply with the ICD-10 mandate, it’s certain that it'll have some sort of dependence on one or more external vendors also faced with complying with the ICD-10 mandate.  If you haven’t already made yourself comfortable with your vendor's ICD-10 compliance efforts, you need to begin that process as soon as possible.

The following are some key bits of information you should consider asking your vendors and keep requesting from them until you get their response.  Hopefully you’ll like and accept your vendor’s response to these needs.

Key Things To Pry From Your Vendor(s)
1. Whether the product/service supports both ICD-9 and ICD-10
-     If so, you’ll want to understand by what means or method their dual use capabilities will be delivered; and decide early on if and how you'll implement their approach.
2. When they plan to start customer review and beta testing
-     Depending on your readiness, you may want to be first in line.  Or maybe you'll want to wait for other customers to work out the inevitable kinks.
3. When they plan to complete customer review and beta testing
-     Make sure you sign up within the available customer review and beta testing window. I suspect many vendors will be overloaded and you don't want to be late to the party.
4. The estimated date for having their product available for customer review and installation 

-    This is a key piece of information that you’ll want to work into your roadmap and project plan. 

5. What training, release information and support materials they’ll provide to customers
-     Will your vendor hold your hand or are you largely on your own?
6. Information on the vendor's customer outreach and communication plan
-     Be sure to sign up to receive information and/or participate in any overviews, seminars, workshops, etc.
7. Whether or not your vendor actively participates in local or national user and trade groups
-     Consider partnering with other organizations that use the vendor’s product. Share information and spread the effort to leverage outcomes.
Ask Early and Don’t Quit Until You Get Clear Responses!
Good luck reaching out to your vendors! For more ICD-10 information, be sure Follow Me on Twitter

Sunday, August 19, 2012

Clinical Limitations of ICD-10 General Equivalencies Mappings

Many healthcare payers and providers are utilizing or planning to utilize General Equivalencies Mappings or GEM’s as a primary means of addressing ICD-10 compliance – at least during the period immediately before and after the transition date; and primarily for reimbursement purposes. It's important that organizations understand that GEM’s aren't intended to be “clinically correct” - at least without significant review, discussion and modification.
Four Limitations to Consider:
Organizations planning to use GEM’s may understand the stated and implied limitations of GEM usage.  And there are some clinical considerations these organizations should also be aware of:
1.    Use of the “Initial Encounter” and “Subsequent Encounter” classifier may not always be clear.

2.    An “exact match” may not always be “truly exact” – but rather an “approximate match.”

3.    Codes marked with a “Combination Indicator” are not always consistent.

4.    Some mappings are not anatomically equivalent.
What Clinical Impact Might GEM's Have?
1.   Episodes of care and global periods may not reflect reality.

2.   GEM’s may exclude or include codes in error contrary to your true intent.

3.   The intent of medical policies, business rules and/or clinical analysis & related selection criteria may not reflect original intent.

4.   Reporting of data aggregated using ICD-9 and ICD-10 coded data converted using GEM’s may not be truly comparable.
While GEM’s and casually constructed, purpose-built maps based on GEM’s can be a means to short-term compliance – particularly for purpose of reimbursement, GEM’s are not without risk and can actually present a good argument for native redefinition of diagnoses mappings.

Tuesday, August 7, 2012

Does your Project Require a Project Manager with ICD-10 Expertise?

In my opinion, the answer to this question depends on a number of factors unique to each company:

What is the project management culture at the organization?
A company with a well-developed and entrenched project management methodology may be able to benefit from a PM having more developed ICD-10 expertise because the PM will not have to spend so much time on team management, administration and control activities; rather these tasks and activities will be spread across the team.
Are there ICD-10 specific methodologies, resources and tools available for the PM and team members to use?
A company that has acquired ICD-10 specific methodologies, templates, 3rd party resources and tools for its PM and team to utilize may be able to get by with a PM having little or no ICD-10 expertise as the PM and team members can “acquire” ICD-10 knowledge and expertise from the methodologies, templates, tools, etc.
How big is the project?
A large project may be better served with a project manager having very strong, well-developed project management skills who’s supported by other ICD-10 knowledgeable resources. The administration, analysis, control and reporting requirements demanded by a large project may preclude the PM from being involved in ICD-10-specific efforts and decisions.
What other project resources will be closely aligned with the project manager?
A project staffed with ICD-10 knowledgeable resources that are closely aligned with the PM and in lead positions would potentially obviate the need for the PM to have ICD-10 expertise.
Is there a culture of sharing, information exchange and knowledge curation at the company?
A team that shares information among its members, has systems to capture and curate information and rewards its team members for educating, training and supporting each other would have less need for a PM highly skilled in ICD-10.
So whether your ICD-10 project is currently underway or in the planning stages, I suggest you give some thought as to the level and extent of ICD-10 knowledge and expertise needed by your project manager and team members.