April 26, 2013

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Taking the Business Partner Testing route to achieving compliance

ICD-10 Compliance date in healthcare industry is swiftly approaching and the ICD-10 steering committees of healthcare organizations are now rushing for the management of various tasks associated with ICD-10. The major areas of concern for the ICD-10 program managers include ensuring transactional neutrality with their trading partners and meeting timely compliance. It is absolutely essential that healthcare organizations assess the readiness of their partners and perform a round of testing with their partners transacting new ICD-10 code sets.

CMS set forth the key to success for ICD-10 compliance is to consider ICD-10 as a business initiative and not a code set update and compliance with ICD-10 simply means the ability to accept and send transactions.

ICD-10 noncompliance of trading partners would result in operational challenges necessitating them to make adjustments for reconciliation of billing codes. Also, the providers or clearing houses might face revenue shortfalls due to inability to process new ICD-10 codes.

Healthcare organizations today are looking for solutions to facilitate assessment of trading partners and track their ICD-10 readiness and perform end-to-end ICD-10 Testing with their partners.

Tracking partners for ICD-10 readiness calls for a solution or framework that can help them in the identification of problematic partners and drive better risk awareness among business partners. Also, healthcare organizations need to quickly start automating the tracking and testing process so that staff effort on monotonous everyday jobs can be reduced and better resolution of ICD-10-related issues can be achieved. Proper communication, coordination, transparency and multiple rounds of testing among the trading partners are critical to achieve compliance and mitigate compliance risks.