With the transition to ICD-10 fast approaching, healthcare providers need to focus on making sure they're ready for the switch.
Collaborating and coordinating with payers as part of those preparatory efforts can help everyone involved spot potential issues, according to Dave Delano, project director at
"They get to collaboratively discuss: 'OK, Why are we seeing this variance? What do we want to do about this?'" he says. "It gets the conversation going in advance of going live."
In order to help payers and providers work together on testing, the nonprofit Massachusetts Health Data Consortium — which brings together providers, payers, industry associations, government agencies and health technology companies —has partnered with MAeHC and healthcare IT company Edifecs to launch the ICD-10 Collaborative Testing Program for providers and payers statewide.
The product allows transaction, coding quality and business impact testing within Web-based, payer-sponsored communities in a way that aims to maximize collaborative development of testing scenarios. Mr. Delano says it gives healthcare organizations a way to scrutinize ICD-10 readiness.
"It really gives people a view to see where there might be issues with ICD-10 coding and compliance," he says. "This is just a lens to see what it might look like when we actually turn on the ICD-10 switch. That lens, we hope, gives us a view to avert adverse effects."
The product lets payers and providers see how testing results compare with others by facilitating agreement on common test care scenarios throughout the program. "You could have the same hip replacement procedure tested among theoverall testing community, which would be better than providers submitting test data through a single payer," Mr. Delano says. "It all starts from the same initial test case…so there's a sense of benchmarking across the state. If everyone submits their own unique data…then how do you have a sense of how that compares to others and if it is correct or not?"
Typically, Mr. Delano says providers and payers don't work on the "same side of the payment equation." However, in the case of ICD-10, parties on both sides want to achieve a sense of security and comfort — or at least clarity — surrounding potential problems. With the collaborative testing product and services, providers get the benefit of getting a snapshot of what they can expect to see for contracted payment rates associated with the test case scenarios, allowing them to evaluate the financial impact of the transition and coding variance.
Meanwhile, Mr. Delano says payers can discern if they're seeing different coding from different providers. They can then work with those care providers and notify them that their coding isn't in sync with the others in the community.
"That sense of community and collaboration is where we're seeing the greatest value from the program," he says.
Currently, eight Massachusetts payers and nine providers are collaborating to use the testing program, and Mr. Delano says others have shown interest in joining. The health plans include BlueCross BlueShield Massachusetts, Tufts Health, Network Health, Harvard Pilgrim Health Care, BMC HealthNet, Neighborhood Health Plan, Fallon Community Health and Health New England.
As the program gets underway, Mr. Delano says the organizations behind it are eager to see the results.
"It's a bit of an experiment," he says. "We're learning as we go and are just curious to learn more."
More Articles on ICD-10:
It's Go Time: the Final Preparations for ICD-10
ICD-10: Not Just About Codes
5 Benefits of ICD-10 for Physicians