Friday, February 24, 2012

Popular ICD-10 Search Terms Used to Find My Blog

I started this blog a little over 6 months ago and have seen the number of readers steadily increase over that time. One of the interesting aspects of maintaining a blog (or a website) are the huge number of statistics available to help identify and analyze site visitors.  Over the last 8 weeks I’ve had the following visits:

First Time

To me, a particularly interesting bit of information is the search terms that lead prospects to my blog. Of the 1322 unique visits, 412 came to my blog via a search engine, mostly Google. So if the sheer number of search terms falling into a specific ICD-10 "topical category" is a valid indication of all reader interest in that topic, then the following ICD-10 topics are front and center in the mind of my blog readers:
  1. Dual and Double Coding                             (62 terms - Tied with Neutrality)
  2. Neutrality                                                      (62 terms)
  3. Payer vs. Provider Topics                           (28)
  4. Testing                                                           (23)
  5. General Impact                                            (16)
  6. Miscellaneous/Onesy-Twosey’s              (221)
The following are the actual terms used to lead a reader to my blog:

Note: With the exception of the Miscellaneous category, each category contains all of the actual terms used by visitors using a search engine to find my blog.

Dual and Double Coding                
double coding vs dual coding
dual period for ICD-10
ICD 10 dual use period
ICD-10 code double validation
ICD10 double coding
ICD10 dual coding
ICD10 dual processing vs remediation
plan remediation strategies on ICD-10 dual approach
sample reports of dual coding ICD-10

addressing financial neutrality ICD 10
benefit neutrality ICD 10 test strategy
challenges to maintain ICD 10 neutrality
financial neutrality testing for ICD 10
healthcare operational neutrality
how to achieve benefit neutrality with ICD 10
ICD 10 neutrality testing
ICD10 Benefit neutrality
steps for ICD-10 operational neutrality
what is benefit neutrality in healthcare

Payer vs. Provider
about ICD-10 for payers
business scenarios for healthcare payer
difference between payers and providers
difference between provider and vendor us health care
ICD 10 changes in payer side
ICD 10 payer side impact
ICD-10 impact on payer enterprise
impact of ICD 10 on payers
the difference of ICD-10 impact  on payers and providers

defining testing for ICD-10
how do you test operational neutrality ICD-10
ICD 10 testing for providers
ICD10 need for payers to test with providers
ICD-10 testing questions
ICD-10 testing scenarios
ICD-10 verification
ICD-9 to ICD-10 testing strategy document
providers carry out internal ICD 10 testing
test scenarios for payers for ICD-10

General Impact
financial impact of the ICD-10  on the payer
ICD 10 business impact analysis
ICD 10 delay impact
ICD 10 impact on payers
ICD10 financial impact to provider groups
ICD-10 impact financial
ICD-10 impact to call volumes
ICD10 impact provider questionnaire

Miscellaneous (Just a few select terms)
do you like computerized assisted coding
how will ICD-10 add value to my organization
ICD-10 how will it be beneficial to me
ICD-10 potential payer business opportunities
ICD 10 bored by IT
ICD 10 early entrants
calculating case rate health payer ICD-10
ICD-10 impact on HCC reimbursement
ICD-10 lessons learned
ICD-10 stupid AMA

So I'm not entirely sure of the value of this information other than its indication of popular topics which I should probably spend more time focusing on.

Friday, February 17, 2012

Select Information from ICD-10 Summit - Part 4 of 4

The following information (Part 4 of 4) was from a tweet stream emanating from the Edifecs ICD-10 Summit held on February 15 & 16th. Find more information about that event here => click here

Miscellaneous Ideas and Thoughts Shared by Participants

1.   Need to establish best practices for Medical Policy Remediation.
2.   Recommends conveying what's in it for providers. Payers need to show providers a benefit to get them on board.
3.   Recommends developing a crosswalk, crosswalk analytical tool and payer coordination since some won't meet date.
4.   Establishing an enterprise-wide collaboration and using a consistent methodology are key.
5.   Good testing strategy is based on risk analysis of historical claims.
6.   ICD-10 can't be implemented the same way as past projects. Collaboration is critical.

Comments from Payer-Provider Collaboration Panel
1.     ICD-10 delay will cost payers more money. Hard to keep momentum if official delay occurs. 
2.     Key learning need: ICD-10 constructs as important as actual code values - surprising to @Humana 
3.     Need to define how to measure neutrality and whether it's a viable goal.
4.     Noted importance of analytics in modeling DRG shift.
5.     What direction will CMS take with ICD-10 delay? Thinks a straight-out delay will occur.

Select Information from ICD-10 Summit - Part 3 of 4

The following information (Part 3 of 4) was from a tweet stream emanating from the Edifecs ICD-10 Summit held on February 15 & 16th. Find more information about that event here => click here

Results from Survey of ICD-10 Summit Participants
1.   Most attendees uncertain about whether ICD-10 will drive down healthcare costs for their organization.
2.   89% of attendees believe impact of delay on those on track wasn't adequately considered.
3.   No real support for the idea that delay will make implementation better.
4.   Defined Neutrality process for your org.? 33% say yes, 51% say no.
5.   Targeting Neutrality as a goal? 79% say yes, 15% don't know.
6.   Test data creation - some challenges, but respondents weren't overly concerned.
7.   Survey indicates that 40% of attendees will complete internal testing in Q1 2013. Suggests too late.
8.   85% of attendees believe ICD-10 granularity will better support quality efforts and improve outcomes.
9.   Nearly 60% of attendees have not looked at how they will prioritize their policy remediation work
10. Nearly 70% of attendees have not developed measures to evaluate the business impact of medical policies.
11. Who is sponsoring #ICD10 in your org. 52% report it's the CEO or COO. 
12. What are the people challenges - 55% say business/tech SMEs.
13. What technology challenges do you have? 39% say reporting & analytics.

Select Information from ICD-10 Summit - Part 2 of 4

The following information (Part 2 of 4) was from a tweet stream emanating from the Edifecs ICD-10 Summit held on February 15 & 16th. Find more information about that event here =>  click here

Survey About “Neutrality”
  1. If you don't define neutrality, you run the risk of miscommunication.
  2. Defined #1- Maintain the current claims acceptance rate.
  3. Defined #2 - Maintain the number/rate of inquiries.
  4. Defined #3 - Maintain the rate of electronic claims.
  5. Defined #4 - Maintain the claims reimbursement amounts.
  6. 6 Dimensions of Neutrality: Payment, Benefit, Revenue, Clinical, Operational and Financial.
  7. Payment: ID where DRG shift can occur, likely impact and ways to get back to neutral.
  8. Benefit: No expansion or reduction in benefits or out-of-pocket costs.
  9. Revenue: No significant increase or decrease in reimbursement.
  10. Clinical: Having approximately the same number of candidates in these programs that you have today.
  11. Operational: No negative trends in KPIs and servicing metrics, e.g., first pass, pend rate, etc.
  12. Financial: Cumulative effect of the variance in the previous neutrality dimensions.

Select Information from ICD-10 Summit - Part 1 of 4

The following information (Part 1 of 4) was from a tweet stream emanating from the Edifecs ICD-10 Summit held on February 15 & 16th. Find more information about that event here =>  click here
Results from an ICD Health Insights Survey
1.   Organizations that are further along report more challenges than anticipated. Scenarios and managing high  volume of remediation are hard.
2.   Greatest technology challenges: Enterprise Analytics ranked 1st, followed by legacy system modernization.
3.   IT not as concerned about technology side of #ICD10 getting done as much as business is. For business roles, reverse is true.
4.   Most challenging area: processes and interfaces. Adapting new and revised business processes is ranked highest.
5.   93% said they had budgeted appropriately. IDC questions optimism in that regard.
6.   Budget - no real difference in answers between IT and biz roles. Interesting!
7.   Has your organization budgeted appropriately for ICD-10 testing? 46% say no, 37% say yes, 17% said who knows? 
8.   Confidence in finishing testing by deadline: 41% confident, 36% somewhat confident, 12% doubtful.
9.   94% of respondents stated they are responsible for ICD-10 testing on either tech or biz side.
10. Importance of testing key processes: claims adjudication, app interfaces, provider contracts rank highest.
11. Less than 20% indicated they were less than confident in completing testing on time.
12. Limited ICD-10 external testing activity so far. Fewer than half of respondents have gone beyond initial steps.
13. Managing test data - volumes and standardization of ICD-10 test data rank as highest data challenges.
14. More concern around analyzing test results - ranked higher than producing test data.
15. Most significant challenges to ICD-10 conversion testing: staff resources and coordination w/ trading partners and external entities.
16. Testing is key and analytics are critical for #ICD10 success.

Thursday, February 16, 2012

Which vendors serving the ICD-10 segment would I visit at HIMSS 12?

I'm interested in ICD-10 with a specific focus on its impact to healthcare payers, providers who bear risk and the software vendors providing solutions to those two healthcare segments. I want to learn about new entrants to the ICD-10 healthcare solutions marketplace; not so much about the large behemoth vendors and Big 4 consulting firms that don’t impress me as offering leading edge products and ideas; or if they do, their entry cost is prohibitive for many small and medium sized firms.
Here are some specific vendors whose products and services I’m looking forward to learning more about during the HIMSS 2012 conference in Las Vegas

Mapping & Translation Tools
3M Health Information Systems
Billians HealthDATA/Porter Research
Health Language, Inc.
Healthcare IT News
HighPoint Solutions, Inc.
HIT Exchange

AAJ Technologies

Atrilogy Solutions Group Inc
Hexaware Technologies
Fulcrum Methods
Kirby Partners
North Highland

Santa Rosa Consulting

Friday, February 3, 2012

Who says ICD-10 doesn't have any benefits? These guys do...

The AMA and a high-profile industry expert on the provider side recently came out against the pending ICD-10 mandate.  While this is not totally surprising and I can’t say I don’t appreciate where they are coming from, I don’t understand how these people are stating that ICD-10 will not provide any benefits.
So who said ICD-10 is without benefits?
Dr. James L. Madara, executive VP and CEO of the American Medical Association (AMA) stated the following in a letter to  John Boehner, Speaker of the House of Representatives:
   "The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patient care" See this 
A Dr. Jason D. Fodeman penned an Op-Ed piece in the Washington Post Examiner that "Congress should stop the coming medical billing fiasco.”
Dr. John D. Halamka, CIO of the Beth Israel Deaconess Medical Center and CIO and Dean for Technology at Harvard Medical School stated:
   “ICD-10 is a costly project that will have no benefits and if we're truly successful, the best we can hope for is that no one will be too upset that we implemented it.” John's article
It was John Halamka’s statement that took me by surprise.  I thought he of all people would have a more realistic and balanced understanding and viewpoint of the ICD-10 mandate.
So here’s a laundry list of “benefits” that ICD-10 will provide directly and indirectly to healthcare consumers in the United States.
ICD-9-CM is out of room. Every year, more out of sequence codes are added, which creates confusion for coders because the code isn’t where it should logically be.
Treatment techniques and methods have evolved over time. The limitation on expanding ICD-9 is the reason why few new procedures have been approved. Not all advanced treatments can be coded using ICD-9 accurately. With ICD-10-PCS, the number of procedures for which new codes are likely to be granted will rise. If many more separate procedures can be coded, a differentiation between the simple and complex procedures will be possible. <= From Code Smart News

Provider Reimbursement
Improved precision in documentation of clinical care will greatly improve the likelihood of submitting accurate claims the first time around and receiving reimbursement for a range of procedures.
Specifies procedures by degree of difficulty.  ICD-10 allows certain procedures to be subdivided by difficulty.
Fewer miscoded and rejected claims due to greater specificity in ICD-10 augers for a shorter claims payment cycle coupled with lowered administrative costs – freeing up resources for patient care improvement efforts.
Improved reimbursement rates due to appropriate payments of new procedures.
Accurate incentive payments for Pay for Performance and quality-based reimbursement programs.
Discourages up-coding and fraud.  More specificity will make it harder for providers to lump patients into a more severe disease and/or procedural category.
Care Management
Serves as the basis for implementing quality of care measurement and movement to a payment system based on quality and outcomes.
Provides improved disease and case management, as well as wellness programs.
Assists with assigning quality of care indicators and completing outcome assessments.
Tracking of healthcare-associated conditions.  ICD-10 allows much greater explanation and accountability for adverse events that occur within healthcare institutions.
Specifies reasons for patient noncompliance.  The current system offers one classification for patients who fail to follow a recommended regimen, while the ICD-10 offers at least eight.
Physicians and hospitals will have better information about their patient populations for use in quality and outcomes-focused programs. Patients who would benefit from care management programs will be better identified for those programs that can improve their health
Supplies providers with detailed information about diseases they treat.
Aligns with EHR.  The conversion to ICD-10 will ensure that electronic medical records, value-based purchasing metrics, and meaningful use incentive programs speak the same language and align with a standardized physician problem list.
Enhances utilization management by facilitating exchange of patient profile information across the care process and hospital resource management.
ICD-10 makes it easier for public health officials to track diseases and threats, dangerous settings, and even acts of bioterrorism.
Detailed data on injuries and accidents such as where they occur, what part of the body was injured, and what implements were used.
Enables enhanced public health surveillance and reporting.
Precision in reporting complications related to medical devices.  ICD-10 allows providers to be much more precise in describing the nature of the malfunction.
Support modern-day research via improved population identification & severity stratification.
Change is never easy. I understand the large demands placed on all stakeholders in today’s healthcare environment: EHR’s, meaningful use, ACO’s, HIPAA 5010, etc. But converting to ICD-10 is not without reward and will benefit healthcare all around from physicians to support personnel to payers to industry and ultimately to patients. Instead of dismissing ICD-10 out of hand and making clearly lop-sided statements that ICD-10 doesn’t provide any benefit, I would urge the AMA, healthcare providers and leading voices to acknowledge reality – if nothing else than to lend their argument against ICD-10 more credibility.

Wednesday, February 1, 2012

It’s October 2013 and Your Transition to ICD-10 is Over - Now what?

The short answer is: It’s not over yet!  For at least the remainder of 2013, various areas within your production operations should be monitored to assess how well you’ve effected the transition to ICD-10.

The following are some of the major areas and activities you’ll want monitor in the 4th quarter of 2013:

Claims Business Processing
1. Are claims containing ICD-9 codes with dates of service (professional) and discharge dates (institutional) on or after October 1, 2013 being rejected?

2. Do claims received from your trading partners and business partners adhere to agreed-upon formats and parameters?

3. Are member benefits, service limits and provider contract terms being correctly applied by your claim adjudication processes?

4. Is there a rise in specific claim edits or are there exceptional claim edits that may indicate unanticipated scenarios were not addressed?

Reporting/ Business Processing
1. Are operational reports produced off your production system and analytical reports produced from your data warehouse correct?

Inbound EDI
1. Have there been out of the ordinary exceptions related to processing files received from your vendors and business partners?

Outbound EDI
1. Have there been out of the ordinary exceptions related to creating files for your vendors and business partners?

Batch Processes
1. Have your batch processes been completing without exception?  Specifically claim adjudication, explanation of benefit statements and provider payment transactions? 

Identifying areas to monitor and defining how exceptions may manifest themselves in these areas will assist your organization with developing test strategies to mitigate or avoid heartburn in late 2013. 

For more information, see my previous posts on ICD-10 testing: