The quality of a decision most often is a function of the information you rely on to make that decision. In the next two years, ICD-10 program managers will have to decide:
- What partners should I perform transaction testing with?
- How can I use my resources best to help ensure readiness?
- What is the scope of issues that my contingency plans must address?
The likelihood is that you already have some of the information you need to make these (and many other) critical decisions. However, there is a lot you likely don’t know, and this brings to mind the well-known quote from former U.S. Secretary of Defense Donald Rumsfeld:
“[T]here are known knowns; there are things we know that we know. There are known unknowns; that is to say there are things that we now know we don’t know. But there are also unknown unknowns – there are things we do not know we don’t know.”
Because ICD-10 preparation depends on the readiness of many organizations outside of your direct control, the only way to ensure readiness is to gather the requisite data from them. Let’s use Rumsfeld’s three categories to think about this process.
What You Know
There is a great deal you already know. Providers know who their critical third parties are. Your vendors, payers and trading partners are all obviously critical, and you will want to monitor them closely. For a small practice, this may be as simple as working with your management software supplier and clearinghouse. However, large providers must deal with a much larger set of these entities, as well as facilities, departments, IT infrastructure and staff. Complexity and interdependencies will grow with the number of these that you must track.
Payers already know the claims volume, value and complexity for the providers from their claims systems. They also may have categories for their providers, which can be sorted by tier, specialty and contract status. Depending on the size of provider networks, payers will need to make decisions about with whom they will perform transaction testing.
These known knows will be necessary, but not sufficient, to make the key decisions required during the next two years.
What You Know You Don’t Know
For payers, the most common unknown involves people. We hear very consistently that payers need to reach out to providers to find the right contacts for ICD-10 readiness. It’s very hard to determine readiness, however, if you don’t know who to ask. Once you do know who to ask, you will want to know if they are doing the right things in terms of preparation. Is a large hospital following the American Health Information Management Association’s (AHIMA’s) best-practice model? If so, the risk they present should be lower than that of a hospital that is not using the model. You therefore can have a higher degree of confidence when scheduling and prioritizing testing with such a hospital.
For providers, ICD-10 involves a great deal of staff training, as well as ensuring systems readiness. In many cases you will need to ask the relevant people to integrate these issues into your overall project plan.
Both payers and providers will want to identify and track dependencies, risk and tasks. As circumstances change, you will want to ensure that your data stays up to date. What if a vendor delays a critical software upgrade? Who will be affected? What will be the business impact? How should testing plans be changed?
What You Don’t Know
You don’t know what will change. In any large group, such as a staff or provider network, change is inevitable. Just keeping up with the change within your contact list will be critical. In addition, testing may reveal new sets of issues that may require a response.
The best way to think of this category is to consider what information you will need at what stage in order to make the best decisions possible. For example, what information will you need to prioritize testing, and when will you need it? Creating a good ICD-10 project plan will ensure that you have the best data available, when you need it.
Building that base of knowledge will take time, however, and the clock is ticking.
About the Author
Hugh Kelly is the vice president of marketing and sales for Avior Computing. Mr. Kelly has more than 20 years in the software and technology business at organizations ranging from start-ups to publicly traded companies. Mr. Kelly has been involved in all aspects of marketing and sales, with considerable focus on channel development. During his executive tenure, his organizations have raised over $200M in external capital. He is a venture partner at Ascent Ventures.
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 From transcript of the U.S. Department of Defense briefing on Feb. 12, 2002 at http://www.defense.gov/transcripts/transcript.aspx?transcriptid=2636