Wednesday, December 26, 2012

Social Media Leaders in the Great ICD-10 Discussion

Last week Phil Dolan interviewed Carl Natale on the subject of using social media to share and/or acquire information about ICD-10. You can see the 2-part interview here: Part 1 and Part 2

As someone who works in, studies and shares ICD-10 information on a regular basis using social media, I thought I’d share some information as to how I leverage social media to both acquire and share useful ICD-10 education, planning, assessment, remediation and testing information. In this 1st part of my 2 part post, I’ll identify who I believe are the social media leaders among the various categories Carl outlined in his interview. In the 2nd part I’ll share techniques and tips for locating and sharing ICD-10 information via social media channels.
I don’t represent anyone other than myself; I am not a Vendor, Government Organization, Provider, Association Community Manager or Payer – although I will say my knowledge and perspective are largely focused from the perspective of a payer and risk-bearing provider. Also, the ICD-10 social media sources listed here are not intended to be an exhaustive list - just a sampling of what ai think are good sources..
What Entities Share ICD-10 Information via Social Media?

Most players in the ICD-10 space are sharing information using social media and using multiple different media and channels to do so.  Moreover, as Carl notes, each player category seems to have a common social media profile and editorial agenda. Some of these entities offer a wide range of media formats including tweets, newsletters, email updates, pod casts, webinars, conference calls and even a talk radio show.
Federal & State Government
Part B News: @PartBNews On Twitter      Their Blog
State Medicaid: (Created by Noblis)  A treasure trove of ICD-10 information!

Industry Associations
AAPC: @aapcstaff OnTwitter   Their ICD-10 Blog Also, AAPC has recently created an ICD-10 discussion forum.  It’s new and unproven but I’ll share it here. 

American Hospital Association: @AHAHospitals On Twitter   Their ICD-10Blog  

Pennsylvania Medical Society: @PAMEDSociety On Twitter    Their ICD-10Blog
Tennessee Medical Association: @TNMed on Twitter  Their Web Site
Wisconsin ICD-10 Partnership:   Not On Twitter  Their Web Site
Sponsored Communities (Vendor backed)
These are interesting hybrids of vendors and industry associations.
ICD10 Watch:    @ICD10Watch On Twitter     Their Web Site  (3M) 

ICD10 Monitor: @ICD10_Monitor On Twitter Their Web Site (OptumInsight) 

ICD10 Hub:       @ICD10Hub On Twitter         Their Web Site  (AAPC & Navicure) 

Technical Publishers/Magazines

Healthcare Finance News: @HFNewsTweet On Twitter      Their Web Site

Information Week Healthcare:    @m_mcknicle On Twitter    Their Web Site  

Physician Business Technology: @PhysBizTech on Twitter   Their Web Site

Vendors & Consultants Representing Vendors
Vendors (some with loosely-coupled front-ment) are incredibly active in social media, partly for reputation management but mostly to promote their business and develop a pipeline (IMO).
3M:                @3MHISNew      Their Web Site 

athenahealth: @athenahealth      Their Blog 

Brad Justus:   @Brad_Justus      His Web Site

BridgeFront:  @BridgeFront      Their Web Site

Edifecs:          @EdifecsToday  Their Resource Library                

HC Pro Inc:    @HCPro_Inc      Their Resource Library  

Elsevier:         @ICD10Online  Their Web Site

Jim Denny:     @J_Denny         Navicure's Web Site

Ken Bradley:  @Ken_Bradley  Navicure's Web Site

Medical Reimbursement: @MedReimburse Their Web Site

Mike Marrigo: @marrigo            No World Border's Web Blog

Navicure:         @Navicure          Navicure's Web Site

OptumInsight: @OptumCodin    Their Resource Library

Precyse:           @PrecyseTweets    Their Web Site  

WEDI:            @WEDIonline        Their Web Site

Hate to say it but I don’t have any good recommendations in this category.  It’s dis-appointing.  I guess perhaps that’s why I do what I do.  See @ShimCode in Individuals & Untethered Consultants below. 

Providers – Institutional, Professional & Ancillary/Other
Just like Payers above, I don’t have any good recommendations in this category.  I’d like to stretch and add the American Medical Association (@AmerMedicalAssn) and the Medical Group Management Association (@MGMA) into this category but, in my opinion, neither organization provides any good ICD-10 information; at least any information you don’t have to pay for. 

Individuals & Untethered Consultants
There aren’t too many in this category.
Kristi Stanton - @codercoach On Twitter     Her Blog
Steve Sisko (Me) - @ShimCode On Twitter My Blog  (You're reading it)
I hope this information is useful.  Check out my 2nd part next Thursday where I’ll share techniques and tips for both locating and sharing ICD-10 information across various social media channels. 

Remember, it’s always better to give than receive!
Happy New Year!

Tuesday, December 25, 2012

My Thoughts on Using Social Media to Acquire Useful ICD-10 Information

I’ve had a week off from the grind and was inspired by Phil Dolan’s interview with Carl Natale about Using Social Media to Acquire Useful ICD-10 Information.  (See the following).

So I’m sharing the highlights of a post – or probably a series of posts – I’ll be sharing over the next week. Be sure to check back.
Key Objectives:
· Provide specific information and examples to utilize Social Media to advance your ICD-10 compliance
· Share techniques and tips to minimize time sifting for the Good Stuff
· Offer specific ICD-10 information sources and tips for maximizing the value of each source.

Who are the social-media sources of ICD-10 Info?

· Government – Federal & State
· Industry Associations
· Sponsored Associations
· Local Associations & Society’s
· Vendors & Individuals Representing Vendors
· Payers
· Providers – Institutional, Professional & Ancillary/Other
· Individuals

My thoughts on using various social media channels

· Discussion Boards
· Blogs
· Twitter
· Newsletters
· Twitter Summaries (like

Tips for consuming & producing information using social media
So check back before the end of the year.  I think I've assembled some very useful info - gratis.

Merry Christmas & Happy New Year


Wednesday, December 19, 2012

2013 Prediction: Federally-Operated Health Insurance Exchanges Will Flounder

PPACA envisions that in October of next year, health insurance exchanges (HIX) will be the primary method for adding tens of millions of uninsured Americans into the healthcare system.  My prediction is that undefined/complex requirements, enormous technical and operational challenges and a myriad of other distractions will prevent the federal government – and many states – from delivering the promise of HIX’s until later in 2014 – if even then.

Undefined, Complex Requirements

With less than a year until deployment, many key decisions and rules as to how health plans will participate have not been fully defined.

Regulatory variations across states will unduly complicate how health plans serving these states will produce and consume enrolments originated from these HIX’s.

Technical and Operational Challenges

There are major operational and technology aspects associated with implementing and operating a health insurance exchange. It’s not reasonable these aspects will be understood, delivered and tested in less than one year!

Most HIX users are expected to be low-income individuals. The eligibility and enrolment processes and systems needed to enrol, track and process changes for this historically mobile and volatile user base are very complex; ask anyone who has been involved with Medicaid eligibility and enrolments.  Add in the need to determine premium tax credits, allocations and other subsidies and you have one very complex system to design, build and test – again in less than a year.

Coordinating billing and payment flows and all the retroactive additions, cancellations and reconciliations between multiple parties – all impacted by overlapping state laws and department of insurance regulations.


Right now, most states have decided not to set up their own exchange but rather rely on The Feds to create and run the HIX for them. This forces The Feds to take on a much larger role than they originally anticipated. There’s a dearth of healthcare and IT resources. Will the feds be able to acquire the resources to deliver on their gamble?

Like all states, private payers and providers, The Feds (CMS/HHS/IRS/Etc.) are also greatly impacted by the Affordable Care Act, HITECH and new standards regulations. Just about every other program initiated by The Feds – HIPAA 5010, ICD-10, Meaningful Use, etc. – have seen delays and/or scaled back expectations. What makes anyone think that health insurance exchanges will be any different?

So…my prediction for 2013 is that the deployment of federal health insurance exchanges in October 2013 will not happen – at least as originally envisioned.

Friday, December 7, 2012

12 Areas of Risk in Your ICD-10 Project

As payers and providers progress through their ICD-10 project, some common areas of risk will become obvious.  Whether you’re a payer or a provider, the following are some common areas of risk that should be considered along with some ideas for addressing their mitigation.

Area of Risk
Possible Mitigation Approaches
Providers not ready
Outreach. Survey/questionnaires. Develop contingency provider support plans.
Payers not ready
Outreach. Survey/questionnaires.
Identify your metrics. Establish a Workgroup. Test your approaches against your metrics.
Configuration (payer systems)
Utilize a coding specialist to review benefit and contract configurations. Develop tools and methods to assist with configuration changes.
Trading partner Readiness
Surveys. Establish a dedicated workgroup
Inter-dependencies with other systems and procedures
Hold regular meetings. Communication. Ideation of workarounds.
Missed areas
Survey end users. Require formal signoffs from business area leads.
Establish a dedicated team. Employ the use of stubs to enable early end-to-end testing.
Payment Modeling. Encourage provider-payer collaboration
Vendor readiness
Surveys. Repeated follow-up. Collaborate with other users of the vendor’s product(s) Lobby for commonly needed information!
Resource availability
Project plans. Measure hours. Hire resources that can be converted to FTE after project.  Leverage internal SME’s.
Impacts from other projects
Attend project meetings.  Read status reports and meeting minutes.
Educate PM’s and SME’s of other projects as to the various forms of ICD-10 impact.  If possible, avoid enhancements and changes involving ICD, DRG and diagnosis-related information.

While some of the above risks may have greater or lesser impact depending on whether you’re a provider or a payer, where you are in the ICD-10 implementation and the size and nature of your organization, your project should have a risk assessment and mitigation plan that includes these and other potential risks.
For more information on ICD-10, you may want to Follow me on Twitter.


Thursday, November 29, 2012

ICD-10 Medical Testing Scenarios – Be Happy in the Morning – Not Mourning

If anyone thinks they will be able to perform comprehensive testing of all ICD-10 coding and processing scenarios, they’re on a Fool’s Errand. There are just too many potential claim coding and payment processing variations between providers and payers due to how selected ICD-10 codes can be applied to benefit plan and medical management policies.  Add in the unlikely readiness and unpredictability of multiple vendor systems and intermediary processing through claim pathways and you’re on your way to going out of business.

Here are some information, ideas, opinions and random thoughts about using medical scenarios to focus your ICD-10 testing.
What’s Your Scenario? Do You Come Here Often?

Spend some time identifying your most common medical scenarios by determining high volume, high-risk ICD-9 codes. Then look at how the following may alter each of these medical scenarios:

1. Type of encounter (initial or subsequent or sequelae?)

2. Applied specificity (did the patient lose consciousness?)

3. Acute versus chronic

4. Relief or non-relief (intractable versus non-intractable?)

5. External cause (was it caused by an accident? – i.e. Other Party Liability?)

6. Activity (what was the patient doing when ‘injured?’)

7. Location (where was the patient when injured?)

Define standard test data sets for each of these medical scenario variations. Determine which ICD-10 code(s) YOU THINK are associated with each of them. Then get your payer/partner to what THEY THINK and have them explain how they’d process your scenario AND their scenario.
If your existing medical records don’t have enough detail to create these medical scenarios, then make up the data. And start planning how you’re going to improve your medical records!

Healthcare is Local
Consider how your locale, region and state may dictate the composition of your medical scenarios. Certain medical scenarios may apply only to a specific region, locale or state.

“Edge” providers and payers servicing two or more states may have extra work to do.
Focus, Focus, Focus – Choose Wisely

You MUST manage the scope of your medical scenarios –or you’ll end up defining many poorly defined scenarios instead of fewer, more important scenarios that thoroughly reflect your business.
Avoid wasting time on customized variations and edits associated with certain trading partners – unless they represent a major portion of your business

Testing with external partners requires multiple companies to be “ready” and have resources committed to test at the same time.
If ever there was a time to focus on the Pareto Principle it’s with ICD-10 testing.

Either You’re With Us or Against Us
Payers and providers will be impacted by, but may have limited control over, vendor readiness, including their test schedules and ICD-10 remediation logic. 

Make a concerted effort to reach out to your primary business partners and document your interactions with them.  Sometimes you’ll have no control and be ignored. Don’t sit back.  Approach and confront, if necessary
<Lawyering On> Having clear, contemporaneous records of your interactions with business partners is ALWAYS a good thing. <Lawyering Off>

The Scenarios Better Work Good in the Morning
The ICD-10 morning is coming October 1, 2014. No one wants to wake up mourning over a nightmare.  So think about some of what I’ve presented above and make a pledge to make smart choices as to which ICD-10 Medical Scenarios you choose at closing time approaches.

If you want to learn more about ICD-10 and Healthcare IT in general, be sure to Follow me on Twitter.

Thursday, November 8, 2012

Are you Ready for an ICD-10 “Non-Enforcement Period?”

On October 1, 2014 your systems and procedures will have a choice to make: Claims with dates of service (professional) or discharge dates (institutional) PRIOR TO 10/1/14 must be processed based on ICD-9 codes. Claims with dates of service (professional) or discharge dates (institutional) AFTER 10/1/14 must be processed based on ICD-10 codes. This capability is generally referred to in the industry as “dual use” capabilities. 

But Will Dual Use Capabilities Be Sufficient? 

Based on what I’ve read and understand, most payers will establish a policy of rejecting claims that contain the wrong ICD code relative to the currently defined 10/1/14 compliance date; either the claim is processed or rejected. But what happens if CMS waffles again and allows a “non-enforcement period” subsequent to 10/1/14?  Perhaps allowing providers to submit claims containing ICD-9 or ICD-10 codes without regard to date of service (professional) or discharge dates (institutional) - just like CMS did earlier this year with HIPAA 5010 transactions.
Some Questions for Now - Rather Than Later

Will your systems and processes be flexible enough to accommodate the non-enforcement period? What design approaches, planning and testing considerations can you make now to  accommodate potential relaxation of the ICD-10 compliance date? If you are dependent on vendor solutions, are those solutions capable of both dual use and flexible use?