Partner with providers to ensure ICD-10 readiness

As insurers prepare to switch to ICD-10, some are shifting their focus to coordinating with providers, particularly small to medium doctor offices, to ensure a smooth transition next year to the new code set, AIS Health reported.

Particularly challenging to insurers is guaranteeing providers' ICD-10 systems are tested and ready to operate come the October 2014 compliance deadline. Insurers don't want the codes to cause them to pay too much for services, but they also want to ensure revenue neutrality for providers, David Barth, senior director of strategic development for Post-N-Track Corp., told AIS Health.

Independence Blue Cross, for example, expects to be ready for the ICD-10 implementation despite the multiple changes to the rule, which as FierceHealthIT previously reported culminated in a one-year deadline extension, that affected its momentum. But the Philadelphia-based insurer is still concerned about whether its providers will be prepared.

"We can control our systems, process quickly and accurately, but what is more difficult is that there are tens of thousands of physicians in the Philadelphia region that we deal with on a daily basis and making sure all of them understand what ICD-10 is and what they need to do to get ready," John Janney, senior vice president of healthcare reform implementation and transformation for IBC, told AIS Health.

To help boost the provider community's ICD-10 readiness, IBC has created a new outreach program called "What's Up Wednesday," which is a "massive conference call held for community providers from around the area," Janney said. One recent call attracted 400 different providers.

Additionally, IBC has started an ICD-10 testing program that collaborates with its largest-volume providers. The program is "not unlike what the Uniteds and Cignas of the world are doing," Janney said.

Concerns like IBC's is why Post-N-Track Corp. suggests insurers focus on its largest providers. "Something like 20 percent of your partners may make up 80 percent of your business," Barth said. So insurers should work with large providers like Mayo Clinic, for exampkle, to determine how ICD-10 will impact its oncology department since cancer treatment is so expensive.

But despite reports that many providers are struggling with the transition from ICD-9 to ICD-10, the American Hospital Association and the Blue Cross Blue Shield Association in June assured Congress that its members are on track for implementation.

To learn more:
- read the AIS Health article

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