ICD-10 Compliance from the Health Plan Perspective

Friday, December 23rd, 2011
This post was written by Jackie Lyons

A three-step process for resolving discrepancies between ICD-9 and ICD-10 codes has allowed Blue Cross Blue Shield of Michigan to complete its version of the General Equivalence Mappings (GEMs) and move closer toward ICD-10 compliance readiness.

However, not all health plans are as prepared for ICD-10 implementation, according to healthcare executives that participated in HealthEdge’s recent Payor Market Survey. With less than two years to go until ICD-10 must be fully implemented, only 22 percent of the respondents surveyed felt that their organizations were “completely prepared,” while 36 percent listed their organizations as “somewhat prepared,” and 37 percent reported that they were only “starting to prepare” for this important new standard.

“At this point, payors should be well on their way towards meeting ICD-10 mandates,” said Ray Desrochers, executive vice president of sales and marketing for HealthEdge, in a MarketWatch press release. “Our survey instead revealed that many organizations are behind schedule, and many payor executives are struggling to address business needs while simultaneously trying to avoid pouring more money into the remediation of their outdated technology infrastructure. It is critical that payors make evaluating and remediating their IT systems a priority in 2012, so that they are ready to both meet the 2013 ICD-10 deadline and the other rapidly evolving needs of the new healthcare marketplace.”

Dennis Winkler, ICD-10 technical program director at Blue Cross Blue Shield of Michigan, described where health plans should be on the ICD-10 timeline at the start of 2012.

“As we look at and enter into 2012, we really expect, and we would hope that most payors in the industry are in a position of taking their resulting maps and applying it to their internal infrastructure – whether it’s application programs or your analytics environment,” he said.

According to Winkler, organizations should have the incorporation of the business changed activites, such as the maps, laid into the operational infrastructure, such as the programs. Therefore, they can commence testing from an end-to-end standpoint in the second half of 2012. This leaves the remainder of 2013 to do external testing with the constituents.

Winkler will share the health plan’s mapping strategy along with other organizational readiness tactics during a 45-minute webinar on January 18, 2012.

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