there is opportunity for either more
straight-through claims processing
or to investigate a greater number of
claims based on specific criteria.
✔ Carriers will receive code sets even after the implementation date of October 1, 2014. This may happen because
the provider is not a covered entity
under HIPAA, or if it has an exemption. Either way, carriers must be
versatile enough to handle both situations and pay bills accordingly.
✔ Did you miss an internal area that
uses ICD- 10 during your assessment
phase? If so, then just make the fix. It is
also important to establish the expectation that there may be unknowns in
order to minimize frustration within
✔ Carriers will need to understand any
gaps in bill review systems after ICD-
10 code set implementation. This is
because some edits in bill review systems were done because ICD- 9 was
so non-specific that it created more
work to review the care.
A recent snapshot survey by Aloft
Group,1 a Newburyport, Mass. healthcare
branding and marketing firm, found that
74.6 percent of respondents are 25-percent
or less completed in the ICD- 10 code set
conversion. The biggest complaint or reason for not being farther along was time
and limited financial resources (71 percent). Overall, the majority felt they would
meet the 2014 deadline (55.4 percent),
while some were concerned (37.3 percent).
Sixty-one percent of respondents felt one
of the most important aspects of a system
that uses ICD- 10 was the ability to run dual
reporting (ICD- 9 and ICD- 10) followed by
assistance with formalized user training
plan and education to improve physician
acclimation (57.7 percent).
Certain areas outlined above are crucial
for readiness with ICD- 10 implementation.
Best practices can only be achieved by uti-
lizing the industry information where mul-
tiple guides for providers and carriers are
available to manuever the multiple changes
that are heading our way. Ask any vendor
that integrates with your system and cur-
rently provides ICD- 9 codes what it is do-
ing to ensure readiness, and how it plans to
connect all the various streams together to
ensure a successful transition to this man-
1. John DeGaspari, A Look at ICD- 10 Readiness,
Healthcare Informatics, March 1, 2013.
Michele Hibbert-Iacobacci, CMCO, CCS-P,
is vice president of information management
support at Mitchell International. For the past 25
years, Iacobacci has worked with major casualty insurers in implementing rules committees,
quality assurance, risk management, compliance programs and review processes necessary in delivering objective bill review systems.
She is a certified clinical coding specialist (
CCS-P), a certified medical practice executive officer
(CMCO), and a member of the American Health
Information Management Association (AHIMA).
For more information, visit www.Mitchell.com.
Fire & Arson Investigation
Investigation & Analysis
Construction, Design &
Materials Defects Forensics
20 JULY 2013 60th Anniversary Claims Magazine PropertyCasualty360.com
Nelson Architectural Engineers, Inc.
(NAE) is a globally recognized
forensics and consulting
firm specializing in
and Cost Estimating.