Massachusetts Launches Statewide Initiative Ahead of ICD-10

money and pillsInternational Classification of Diseases (ICD) codings newest iteration, the ICD-10 coding standard, will become mandatory on October 1, 2014.

The new standard, which will result in a steep increase in the number of procedure and diagnostic codes, is being watched closely by insurers and medical organizations. Both of these groups have voiced their concerns about ICD-10 coding mandate. For instance, the American Medical Association cited some concerns in a new report, renewing its call for the Department of Health and Human Services to reconsider its ICD-10 deadline. The deadline has already been repeatedly delayed for five years. Now the Department of Health and Human Services says they can delay no longer, as the standard has already been in place in other countries with the U.S. lagging behind.

But there is one state that isn’t leaving ICD-10 implementation readiness to chance.

Early in February, it was announced by Massachusetts that the ICD-10 Collaborative Testing Program would be launched. This program aims to reduce the costs, time, and risks associated with ICD-10 compliance. These are matters that the American Medical Association expressed concern over.

The Collaborative Testing program does not currently cover Medicaid and Medicare providers, but it does cover the state’s nine largest commercial providers and payers. It is believed that this effort is unique and could possibly branch out into neighboring states in the near future. It will remain in place after the October 1 ICD-10 launch.

The Collaborative Testing Program

The Massachusetts Health Data Consortium is coordinating the testing scheme. They are a non-profit organization that works on a number of public policy and technical topics that are related to health care provisions in the state. In this case, they are working with the Massachusetts eHealth Collaborative, which is another non-profit that is focused on improving health care delivery by promoting technical solutions.

The secure testing portal currently has approximately 1,500 pre-built clinical scenarios. Hospitals are able to test the scenarios to check how well they move through the payers, as well as how well providers code using the expanded ICD-10 codes.

Using the testing program, in addition to the use of physician consulting to help doctors and their staff make their ICD-10 implementation much smoother, can make transition easier. Physician consulting services can help providers make good use of the collaborative testing program and any other tools that are made available to help providers reduce the costs and the time that it will take to convert to ICD-10.

Using the tool will tell physicians and staff members how well they are coding. This is a system that can issue coding variance reports to both payers and providers, making it much more efficient in a number of ways.

Hammering Out The Details

As system remediation moves on, the details are being hammered out. This is something that delays ICD training. However, this is where physician consulting comes in very useful, streamlining ICD training and reducing the learning curve as much as possible.

What most agree on is that internal readiness and ICD training are very important for success. Thus far, the larger hospital systems seem to be on target. This is due to them thinking about ICD readiness for quite some time. They’ve implemented some planning and turned to healthcare consultants specializing in coding, billing, and other practices essential to the operation of a hospital or private practice.

The main issues and where the details need to be hammered out are with payers and providers. Without the proper assistance, end-to-end testing may not be able to occur. If that does happen or it happens very close to or after ICD implementation, things may not go as smoothly as desired. Glitches can come about and there would be very little time to fix them. This is why there are initiatives to push ICD-10 readiness so that providers and payers are not working out glitches on or after October 1.

Some of the potential problems include:

  • Medicare error rate increasing when the error rate has already crept up to 10.1 percent, which translates into inaccurate payments of $36 billion under ICD-9.
  • Providers and payers still not gathering all of the accurate and important information needed to ensure complete documentation.
  • Inaccurate documentation could be the baseline during the transition from ICD-9 to ICD-10. It is best to ensure that current documentation is as accurate as possible.

For those that haven’t started trying to eliminate the hassles can start now and still be ready in time for the October 1 implementation date. By getting started as soon as possible, the transition can be much smoother than it would be if the transition started later.


Now is the time for ICD-10 implementation so you are ready by the October 1 deadline. To get ready, call MD Pro Solutions at (508) 946-1665, toll free at (800) 853-8110, or visit our contact page.