Clinix ICD-10 Readiness Plan

For the latest information visit the Clinix ICD-10 Resource Hub.

 

 

End to End Testing: Clinix Completed end to end testing with the following  Medicare Administrative Contractors (MACs) the last week of April 2015:

  1. Palmetto
  2. CGS
  3. Cahaba

Clinix assumes that all parties required to be compliant for ICD-10-CM codes by October 1, 2015 will be compliant on that date.  This is based on the regulations and following assumption by CMS that all parties will be compliant, or will implement methods to be able to send and/or receive ICD-10-CM codes as necessary, on October 1, 2015.

Under that assumption, Clinix’ plan for ICD-10-CM readiness is based on the requirement that services with a date of service on or after October 1, 2015 must use ICD10-CM codes rather than ICD-9-CM.  Clinix will modify its systems to require use of ICD-10-CM codes on or after October 1, 2013 unless the third party payer of insurance claims associated with the service is not ICD-10-CM code compliant – and Clinix will provide its clients with the ability to so designate those non-compliant third party payers in order to eliminate or reduce manual intervention.

Clinix will neither allow entry of nor store both ICD-9-CM and ICD-10-CM codes on any single patient encounter.

Clinix will not use the General Equivalency Mapping System (GEMS), or its equivalent, to translate ICD-9-CM codes to ICD-10-CM, and vice versa.  Clinix will take what we believe to be the only proper course of action and maintain both the ICD-9 CM and ICD-10 CM codes in our diagnosis code tables.  They will be, as they are today, date sensitive.  Maintaining both sets of ICD CM codes will provide more accuracy and allow clients to handle various situations such as resubmission of claims after September 30, 2014 that have dates of service prior to October 1, 2014.

Clinix will modify its HL7 interface programs to use the available identifier codes (I9 and I10) to identify which version of ICD code is included in outbound HL7 transmissions to other data trading partners and will request data trading partners to include the same identifiers in their HL7 messages sent to Clinix.

User Interfaces

Entry of diagnosis codes in all parts of the ClinixPM User Interface will be tested for date sensitivity and allow only ICD-9-CM codes for DOS prior to 10/1/15 and allow only ICD-10-CM for DOS after 9/30/15.

Testing Policy

To avoid unnecessary development, we will force the DOS to be on or after 10/1/15 on any test records we might submit to other data trading partners rather than requiring or allowing users to enter both ICD-9-CM and ICD-10-CM codes on encounters dated prior to October 1, 2015.

Insurance Programs

Insurance Master Tables will be altered to include a new flag to indicate if the insurance company’s product represented by the master table record is or is not ICD-10-CM compliant.

Insurance programs will have to be altered to use the new field in the Insurance master table to know if the payer or carrier to which the claim will be transmitted is ICD-10-CM compliant, or not.  This will enable the Clinix insurance programs to provide the correct identifier on the ANSI X12 5010 837 claim.  At the present time Workman’s Compensation and Liability insurers are exempt from ICD-10 CM compliance requirements and dates.

HL7 Interfaces

Clinix has to deal with interfaces between our ClinixPM practice management system and external data trading partners.  The problem is that vendors can and will adopt different approaches and policies of how their systems will treat ICD-10-CM, and what they will be able to send TO or receive FROM the ClinixPM system in HL7 or proprietary interfaces.  All of these other vendors/data trading partners will have to deal with the same issues as Clinix, so the variety of approaches could be extensive.  If necessary, Clinix will deal with each inbound interface on a case by case basis.  However, just as the other vendors will almost certainly do, Clinix will have to create a standard outbound data policy; and the recipients of the data will have to deal with our inbound messages as they are constructed by us.

Our staff will be very busy dealing with tweaking working inbound interfaces that contain ICD codes.  We will reach out to all data partners with inquiries about how they plan to handle ICD-10-CM in their outbound files/records.  We will also develop a standard statement of our policies that can be provided to those same data trading partners to anticipate and forestall their inquiries or to respond to their inquiries.

Timeline for ICD-10 CM Implementation

Summarization of transition steps to ICD-10-CM

2010-12

  • Perform analysis and identify requirements and considerations for transitioning to ICD-10-CM

2012

  • Complete gap analysis, define functional requirements, and begin development

2013

  • Complete system development to support both ICD-9-CM and ICD-10-CM
  • Conduct internal testing and begin end to end testing with external partners during the last calendar quarter

2014

  • Complete external testing
  • Provide updated software to customers to support both ICD-9-CM and ICD-10-CM code sets a minimum of four months prior to 10/1/2015

2015

End to End Testing: Clinix Completed end to end testing with the following  Medicare Administrative Contractors (MACs) the last week of April 2015:

  1. Palmetto
  2. CGS
  3. Cahaba