How to work with payers on ICD-10


How to work with payers on ICD-10

You could put off communicating with your healthcare payers until you submit your first ICD-10 coded claim Oct. 1, 2014. What could go wrong?

All kidding aside, early communication will help you test the ICD-10 claims process and gain insight into how reimbursements will be affected after Oct. 1, 2014. That second part will help prepare for DRG shifts. And it puts a price tag on procrastination.

Early communication also will help you develop relationships with healthcare payers. This could help speed responses when you need answers and clarification during the claims process.

The first step is to survey healthcare payers to understand ICD-10 readiness by asking:

  1. Are you prepared to meet the ICD-10 deadline of Oct. 1, 2014?
  2. Where is your organization in the transition process?
  3. Will you conduct external testing?
  4. What will we need to test with you?
  5. When will you be ready to accept test transactions from my practice?
  6. Will you be dual processing, and if so, when will you start?
  7. What will happen if something goes wrong?
  8. Who will be my primary contact at your organization for the ICD-10 transition?
  9. Can we set up regular check-in meetings to keep our progress on track?
  10. Do you anticipate any changes in policies or delays in payments to result from the switch to ICD-10?

In return, providers need to:

  • Communicate the status of the organization's ICD-10 transition.
  • Share the information with the ICD-10 implementation team.
  • Establish regular check-ins — emails, phone calls or meetings — with key payers.

This part of the ICD-10 transition will take time and effort but there will be reward — less financial disruption and stress.