Electronic Health Reporter

Guest post by Anirban Mukherjee, account head at NIIT Technologies.

While most of the worrisome news about transitioning to ICD-10 is correct, the most daunting of tasks are actually the easiest to accomplish. Yet unwittingly, most healthcare providers, following the various help forums and articles, have focused on chalking out a complete ICD-10 transition plan before all else. Then, the plan is too often delayed or scrapped altogether.

The trick to a successful transition starts at the grass-root level: analysis before planning the transition effort and timelines. A detailed impact analysis is critical, and since it is based on historical data, it can never be too early to get this done. Moreover, with comprehensive historical data analysis, the planning effort can be drastically reduced. Consider that NIIT’s research, which analyzed the historical data of multiple providers, has revealed that up to 90 percent of claims utilize less than 5 percent of the ICD codes used by providers. Thus, by focusing on the accurate mapping of 5 percent of the code subset being utilized, 90 percent of the risk can be mitigated.

Financial neutrality is a key concept here. Per comprehensive ICD analysis tools, reports can be obtained for financial, risk-based, reimbursement and remittance analysis. The reports can be further customized, or drilled down, by selecting specific business units and clinical categories. This facilitates identification of potential codes and scenarios in which ICD-10 claims may vary in value, be denied or return a no-map scenario. Further, the analysis aids in building a mechanism to address issues of remittance changes, as well as in creating a framework to support remittance-based trend analysis. A plan and roadmap based on such concrete groundwork, in all likelihood, will be a key indicator of success. 

Statistics indicate a large number of healthcare organizations, mostly providers, are lagging behind. Although organizations starting their efforts as late as January 2014 may still be able to complete their internal mapping and transition by the federally-mandated October 1, 2014, deadline, key aspects, such as rigorous external testing and training (for coders and physicians), will be hard to accomplish in this highly compressed timeframe. Also, such providers will not be prepared to deal with multiple payers using different mapping scenarios.

For example, NIIT’s research team has discovered that only about 35 percent of payers are planning to use the CMS GEM Maps. The remainder will use a mix of custom maps and third party vendor maps. The need for exhaustive external testing and other types of support seems inescapable here. Yet, many providers are erroneously dependent on their products and solutions, completely overlooking the critical need for in-depth analysis, testing and training.

And it gets worse.

Some smaller providers and practices plan to rely on their clearinghouses to come to rescue. While this may benefit some, a large number of practices will lack access to such solution tools, or will have minimal control over variances, a result of using the inflexible maps provided to them.

In addition, different healthcare entities, such as behavioral, dental and vision providers, have highly specific needs and complexities related to ICD-10 that require thorough analysis and due diligence for the transition.

A successful transition to ICD-10 requires detailed analysis, robust planning and guided implementation, in this precise order. Using ready solution frameworks, tools and services from vendors may prove useful in supporting the business case, particularly to reduce cost and accelerate the time to production. And for those who are still at the planning stage, the clock is ticking … and fast. 

Anirban Mukherjee is a certified healthcare professional with more than 11 years of experience in the healthcare industry. His specialties include ICD-10 compliance, claims administration, provider management, sales automation and revenue cycle management.  Mukherjee has a proven ability to solve complex business problems utilizing his deep functional knowledge of claims administration and application of healthcare technology. In 2011 he joined NIIT-Technologies, Ltd. to lend his Healthcare expertise to NIIT customers.