Open Up Payer and Vendor ICD-10 Communications

It’s not too early to reach out and ask questions.

Annie Boynton, BS, RHIT, CPC, CPCO, CPC-H, CPC-P, CPC-I, CCS, CCS-P

Although ICD-10 implementation has been pushed back a year, providers cannot afford to overlook the importance of establishing open lines of communication with vendors and payers. Vendors and payers are on the cutting (and bleeding) edge of ICD-10 implementation. Understanding how the changes will affect them is a critical step in successfully achieving ICD-10 compliance in the practice setting.

Certified Professional Coder-Payer CPC-P

Ask the Right Questions

There are a few key questions that providers and facilities should ask vendors and payers as they begin ICD-10 outreach.

Vendor-specific questions include:

  • Will your organization be compliant with ICD-10 by October 1, 2015?
  • Who are the ICD-10 contact people, and what is their contact information?
  • Will there be additional fees charged as a result of the ICD-10 upgrade?
  • When will our organization be able to test ICD-10 transactions?
  • Will there be additional training needed as a result of the ICD-10 upgrade?
  • What payer organizations are you testing with?
  • Can we test with you? If we cannot, will you make your testing results public?
  • When will we be able to “dual code,” using both ICD-9 and ICD-10?
  • Will you offer customization for our specialty within your products (i.e., clickable templates/matrixes to help with documentation improvement)?

Payer-specific questions include:

  • Will your organization be compliant with ICD-10 by October 1, 2015?
  • Who are the ICD-10 contact people, and what is their contact information?
  • What is your ICD-10 implementation approach? (e.g., will you use General Equivalence Mappings (GEM) files, proprietary crosswalks, or a hybrid approach?)
  • What (if any) are the contractual impacts to the practice as a result ICD-10?
  • Will payers be able to offer any sort of contract-based financial protections as a result of ICD-10?
  • When will medical policies/payment policies specific to ICD-10 be available for review?
  • Are you offering no-cost training assistance to the provider/facility community?
  • When will you begin testing? What types of organizations are you testing with?
  • If we are unable to test with you, will you share the results of ongoing test processes?

Diligence Will Pay Off

It’s not enough to ask these questions a single time. ICD-10 implementation will require constant updates and continued outreach to your vendors and payers. Providers and facilities should plan monthly communications with both vendors and payers throughout 2014 and 2015. Be persistent and willing to share your organization’s ICD-10 plans, as well. ICD-10 will require communication and cooperation on all sides.

Many payers and vendors are developing free training materials and other types of assistance for practices. You won’t know if your payers are doing these things unless you ask. Developing a rapport with vendors and payers today will secure further collaboration as the implementation deadline approaches.

Annie Boynton, BS, RHIT, CPC, CPCO, CPC-H, CPC-P, CPC-I, CCS, CCS-P, is director, Communications, Adoption & Training, Regulatory Implementation Office, at UnitedHealth Group. She has been in the healthcare information management field for nearly 15 years, serving in provider, payer, and educational capacities. She is embarking on the next phase of her career as the principal of Boynton Healthcare Management Solutions, focusing on practice management, compliance, technology, and regulatory preparedness for evolution of healthcare. Boynton frequently speaks and writes on healthcare management. She is president of the Worchester, Mass, local chapter, and has served on the AAPC National Advisory Board.

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Renee Dustman

Renee Dustman

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.
Renee Dustman

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Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.

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