Veterans Health Administration (VHA) Purchased Care (PC) ICD-10 Program Management Support
Altarum helped ensure that Veterans and the families of Veterans continued to seamlessly receive care from non-VA providers during the transition from ICD-9 to ICD-10 billing codes.
Overview
The U.S. Department of Health and Human Services (HHS) adopted a rule in 2009 that required covered entities (health plans, health care providers, and health care clearinghouses) that conduct electronic Health Insurance Portability and Accountability Act standard transactions to move from ICD-9 to the next generation ICD-10 code sets by October 1, 2013. However, as federal and commercial entities began preparing for the ICD-10 transition, the amount of modification and testing required to seamlessly migrate to ICD-10 became apparent and resulted in two postponements with the new official ICD-10 effective date set for October 1, 2015. Within VHA, PC performs claims processing and makes payment for services provided by non-VA providers and therefore, under the HHS rule, is required to become ICD-10 compliant by October 1, 2015.
Altarum was instrumental in PC’s transition to ICD-10 through its role as trusted business advisor. Altarum provided subject matter expertise; provided project management support, including workgroup facilitation, risk management, and change control oversight; established an end-to-end testing schematic to proactively identify and correct defects, process discrepancies, and financial impacts; implemented document management efficiencies to streamline the review, approval, and storage of system design and testing artifacts through the development and maintenance of an interactive SharePoint infrastructure; and established both internal and external communication channels through the rollout of a VHA ICD-10 Internet page for community providers and recurring newsletter for internal VHA PC communication.
Key Successes
For a project of this caliber, end-to-end testing was a necessary requirement, because ICD-10 was much more than a technology implementation; it depended on business processes and business partners. As such, Altarum worked with PC to develop an end-to-end testing schematic that focused not just on technical requirements but also on business objectives, such as clinical equivalency, benefit neutrality, financial integrity, and operational stability. Through Altarum’s support and expertise, PC was positively positioned to deploy ICD-10 remediated software more than 6 months before the October 1, 2015, go-live date and execute an ICD-10 end-to-end testing schematic with testing partners.
Through Altarum’s efforts, PC will be ready to receive and process medical claims on the October 1, 2015, ICD-10 go-live date for Veterans and families of Veterans who receive care from non-U.S. Department of Veterans Affairs (VA) providers. Ensuring that Veterans and the families of Veterans can continue to receive care from non-VA providers without delay or billing issues is paramount for those who require services not available at local VA facilities.