Featured Articles: ICD-10

The Elephant in the Room: time to talk...

Friday, May 31, 2013   (0 Comments)
Posted by: Joy Ingram
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by Lynn Gerlach, Member Services Manager

Can you think of a single moment in the past 20 years when you have been less thrilled to entertain another diversion, distraction or demand on your time and budget? An additional hurdle to surmount is exactly what you don’t need or want. You barely have time to read about another demand, much less deal with it.

So I will begin with an apology. I am truly sorry, but … we need to talk. It doesn’t look like the conversion to ICD-10 is going to be pushed back again, and experts are urging folks not to wait for ICD-11. As much as you’d prefer to ignore the elephant in the room, we strongly suggest that you address it sooner rather than later, making it part of your timeline for the next 18 months. It’s not going to leave you alone, and, left unattended, this animal could run amok.

The Good News

Would you be willing to start with the good news? NWRPCA has been studying the ICD-10 issue for more than a year, seeking solutions and the experts who can deliver them. We have recently selected Priority Management Group (PMG), a Rhode Island firm that offers solid expertise in revenue cycle management — including coding, billing and reimbursement — specifically for community health centers.

Working together, NWRPCA and PMG have designed a comprehensive, flexible ICD-10 preparation program that can put the CHCs of Alaska, Idaho, Oregon and Washington in the catbird seat come next October. The multitude of training opportunities, fashioned for various relevant audiences and learning styles, is already in place. With a dozen unique levels of commitment, the program is meant to flex to the divergent training needs, readiness levels and operating budgets of our 81 member health centers and other FQHCs in Region X.

In just a minute you can view the menu of tools and training modules for yourself, but first I’d like to provide a very brief reminder of where this all came from followed by a quick overview of the PMG program we’re offering you.

The Story behind the Current Flap

The International Classification of Diseases (ICD), regulated by the World Health Organization (WHO), provides the entire world a common language for reporting and monitoring disease. According to WHO, “In addition to enabling the storage and retrieval of diagnostic information for clinical, epidemiological and quality purposes, these records also provide the basis for the compilation of national mortality and morbidity statistics by WHO Member States. It is used for reimbursement and resource allocation decision-making by countries.”

Much of the industrialized world has been classifying causes of death since 1893. In 1948 the World Health Organization assumed responsibility for revising and updating the classification system every ten years. ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990, and its use in the United States was mandated by the HIPAA Act of 1996. However, still using ICD-9 since 1979, the US has been the only member state that has not converted to version 10. Now, with version 11 already threatening, the US is falling further and further behind. It’s almost certain that CMS will not extend the conversion deadline yet again.

“How to Eat an Elephant”

What happens to providers that don’t convert? According to HRSA, beginning in October 2014, failure to use ICD-10 codes will result in reimbursement delays and claims returns. As a Primary Care Association, we find that outcome for our member health centers unacceptable. That is why we have worked with PMG to create a training program that offers all of these features:

  • Comprehensive – if you need it, you should have the option to select it
  • Flexible – offering a spectrum of commitment, independence and price points
  • Timely – geared to the right audiences at just the right time
  • Affordable – providing revenue share for the Region to offset the considerable investment such training might require

The program PMG has designed addresses widely disparate needs, including the minimal needs of the highly independent health center wanting a few do-it-yourself tools; three sets of webinars timed and tweaked for just-in-time learning by the appropriate audience; packaged programs that might include the full webinar set, all the do-it-yourself tools, a diagnostic records review, a remote project manager from the PMG staff, and/or on-site training at your own health center.

The do-it-yourself tools are ready now. The webinar sets, labeled Ready, Set, Go! will be rolled out at appropriate points. The 9-webinar series called “Ready,” available in July, will help the CHC’s project manager organize the team, conduct the gap analysis, and communicate with key vendors. The seven “Set” webinars, ready in winter, will teach the actual ICD-10 code sets to those who will use them. And the “Go” webinars, six in number, will be introduced in October 2014, providing support from the go-live moment through the next critical months.

Facing the Incomprehensible Landscape

But PMG and NWRPCA are not projecting a go-live date of October 1, 2014. When the rest of the country stumbles through the ICD-10 door to face an incomprehensible landscape, our health centers will be in a very different place. Our mutual goal for Region X is a go-live date one year from now, with all Northwest community health centers coding in version 10 by June of 2014.

Why are we pushing you to get ahead of the game, you might wonder? For several reasons, including the same reasons for rehearsing your wedding, taking pre-natal birthing classes, and practicing your keynote address before you present it. This is not going to be a simple changeover. Many in the IT world have likened the code conversion to Y2K. The new code sets represent an increase of 812% in the possible combinations available (although PMG has assured us our health centers will not use all the possible combinations).

Think of the ICD-10 conversion as a garden hose: You don’t have to worry about a kink in your hose until you turn the water on. Wouldn’t it be a good idea, though, to find the kinks before you have to drink the water? We’d like to see Region X cross-walking between ICD-9 and -10 for a few months before the switch is thrown, giving you time to work with your EHR vendor, bring reluctant providers on board, offer extra training to coders who have not been schooled in FQHC-specific coding, and allow your IT specialist a little breathing room.

How the Program will Work

Interested health centers will contract directly with PMG for their desired services. The PCA does not need to be in the middle of your discussion. However, PMG will regularly report to NWRPCA on the investments its Regional health centers have made, returning to the Region a small share of that investment. NWRPCA is committed to using its share to benefit member health centers that have chosen to prepare for ICD-10. Quite obviously, the more Region X health centers that participate in the PMG program, the greater the revenue share to NWRPCA, and the more resources available to help health centers with their preparations.

Finally, it is important to know the parameters of our agreement with PMG on your behalf:

  • You are under no obligation to prepare for the ICD-10 conversion.
  • You are under no obligation to conduct any business whatsoever with PMG at any time.
  • Some revenue share will accrue to the Region regardless of the number of health centers participating, but at a threshold of 36 participants, revenue share will increase significantly.
  • At this time, NWRPCA, unsure of the level of participation to be expected, has not yet determined how it will use its revenue share to benefit member health centers with their ICD-10 preparation. An explanation of that system can be expected in September, 2013.

See for Yourself

And now, there is nothing left but to visit the PMG web site at www.goPMG.com and review the ICD-10 training materials available. Your contact at PMG is Paul Ferazza: 401-616-2048 or pferrazza@gopmg.com. If you have questions or concerns about NWRPCA’s role in the ICD-10 training, you may contact Lynn Gerlach, Member Services Manager, at 206-783-3004 x12.

Hopefully, what was an elephant is now a much less intimidating force. So, as was so eloquently declared by our wartime ally in darker days, "keep calm and carry on."


NWRPCA welcomes and regularly publishes white papers and articles submitted by members, partners and associates with subject matter expertise. The appearance of any guest publication in our Health Center News database represents the views of the author and does not constitute endorsement by NWRPCA of the stated opinions or perspectives, nor does it suggest endorsement of the contributor's products or services.


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