The year-long delay for implementing the ICD-10 coding system placed the eager-and-willing organizations between the proverbial rock and a hard place, while enabling the wary (and those in denial) to procrastinate toward a last-minute, mad-dash scramble.
For those chomping at the bits and bytes to make the switch, the delay offered a mixed blessing in that they would have additional time to make process improvements, even as they trained their staff to learn the new codes while continuing with the current ones.
For those pining for the status quo and another delay, what occurs this October will represent a costly and disruptive wake-up call if another delay miraculously fails to happen.
Michael O’Rourke, Senior Vice President and CIO, Catholic Health Initiatives (CHI),
Englewood, CO, encourages healthcare organizations to use the time effectively, even as the new deadline approaches.
“The additional time allows us to really put more focus, more quality, and more investment into the ICD-10 effort in preparation for clinical documentation and training physicians, clinicians, and coders so we are sure we have a good, quality outcome,” O’Rourke says. “Time is always a wonderful gift. For us, outside of the cost involved, it allows us to have a better outcome for ICD-10, and we will be better prepared. Will compensation be improved? That remains to be seen. ICD-10 allows us to be far more discrete about DRGs, processes, and procedures – and that is better for our patients and should be better for CHI.”
Barbara Waxenfelter, R.N., Senior Manager, Ernst & Young, agrees, noting that most organizations are looking at this as a chance to get it right.
“This delay has provided a perfect opportunity to analyze the output of dual coding and dual processing; to test more vigorously between payers, providers, and clearinghouses; and smooth out all of the kinks before the cutover,” she says. “Having been in the weeds with CMS’ general equivalence mappings, I have a healthy respect for the complexity of the new code set. Much of it lacks straightforward bi-directional mapping and presents huge challenges for reimbursement on both sides of the aisle. Payers, providers, and clearinghouses must commit to rigorous and enhanced end-to-end testing to facilitate a smooth transition and promote revenue neutrality.”
Much depends on how providers are using their time leading up to the October deadline, according to Ana Croxton, Vice President, Electronic Data Interchange (EDI) Products and Services, NextGen Healthcare.
“It can make a huge difference if the time is spent on how to properly code, or it can make little difference if they just kick the can down the road,” she says. “I think the industry is attempting to use the time for additional testing and education, and is encouraging providers to do the same thing.”
Healthcare providers can reap an “enormous opportunity” if they are using the time “wisely by dual coding and advanced medical record training with the coders, along with the deployment of a feedback loop with the physicians and administration,” says Angela Hickman, Senior Consultant, Culbert Healthcare Solutions. “Time and practice will make experts out of coders. What we put into it is directly proportional to what we will get out of it. There is much that will reveal itself in the wake of the extra time that will also allow for better mitigation and resolution prior to the implementation date.”
Working a plan
Ingenious Med
But providers must approach this transition in the right way to achieve the desired results, particularly when it comes to improvements in revenue cycle management, according to Karen England, Revenue Cycle Consultant, Ingenious Med.
“Look at the most frequently used diagnosis codes from ICD-9. Pull patient charts, and code to ICD-10. Focus on anything that results in an unspecified code. Is laterality missing? Is the type of diabetes documented? What about use of insulin? Is the patient’s condition acute or chronic? Addressing and emphasizing the need for this type of specificity will allow for speedier and more appropriate processing of claims and reimbursement,” England says. “In addition to working toward physician compensation, it is important to focus on
MedAssets
timely reimbursement and compensation. Fewer denied claims result in lower AR days and increased efficiencies for coding and billing staff.”
Amy Amick, President, Revenue Cycle Management, MedAssets, concurs with a strategy that concentrates on improving revenue cycle operations.
“At the time of the original deadline, 46 percent of healthcare leaders anticipated revenue loss from ICD-10 implementation,” she says. “That would be on top of already significantly shrinking operating margins.
“We encourage providers to dedicate additional time to improving their overall revenue cycle processes – driving both sustainable impact today, and for the future under ICD-10.
For example, taking advantage of the ICD-10 delay to deploy a clinical documentation improvement [CDI] program today yields more efficient billing and steady cash flow now. CDI has become a stalwart strategy for hospital finance departments to support their revenue cycle, but its importance is further amplified with ICD-10. You can expect payers to demand much more supporting documentation in cases of denial underpayments or audits. An effective CDI program requires both technology and people training – which, again, take time to achieve.”
Ray Desrochers, Executive Vice President, HealthEdge, says he foresees the additional specificity from ICD-10 coding as making a “tremendous difference as payers and providers ramp up care collaboration and risk-sharing.”
Testing, testing
Louis Hyman, Chief Technology Officer, SigmaCare, emphasizes the basics in stressing that “the additional time will make a meaningful difference in generating improved accuracy and efficiency in coding and billing.
“The ICD-10 code set is much more complex than ICD-9, and providers need to ensure they are knowledgeable on the new coding rules,” he says. “The extension also allows vendors to ensure their IT providers are also compliant with ICD-10 and coding information and be seamlessly exchanged with third parties.”
“What often goes overlooked is the need to improve documentation practices,” Hyman continues. “With the size and complexity of the codes, which include laterality and new
manifestations, the need to capture accurate clinical data to facilitate accurate coding will be key to ensure seamless billing processes and avoid callback to providers for additional details.”
That’s why testing among integrated systems is paramount, according to England.
“Physicians must be able to document appropriately, but can the claims make it from the practice management system to the claims clearinghouse to the payer? Testing should not focus solely on getting a claim out the door,” she says. “ICD-10 encompasses a completely different format than ICD-9. Characters are different, alphanumeric formats are different, and the placeholders within ICD-10 are a new concept. Systems need to be able to differentiate between I and 1, 0 and O. The other primary thing to keep in mind is to catalog all systems needing testing. You don’t want to be reminded of that home-grown OR system on Oct. 2, 2015.”
Amick agrees that providers should be looking beyond the code changes and necessary education. “They should be pursuing revenue modeling and potential technology investments now,” she says. “These investments will only serve to prevent obstacles to staff productivity and cash flow down the road.”
Heather Haugen, CEO and Managing Director, The Breakaway Group, a Xerox company, says that based on client reports, the additional time isn’t necessarily helping facilities generate more efficiency, but prepare for more changes in the future.
“Our hope is that the delay will allow those organizations that haven’t been able to prepare for ICD-10 in the past due to lack of resources, to now concentrate on educating their staff and making system and operational changes as needed,” Haugen says. “The real value in ICD-10 is, at its core, its ability to ensure better patient reporting across the organization, from check-in, physician visit, lab requests, discharge, etc. It’s also enabling healthcare organizations to get prepared for ICD-11.”
Regardless, the financial impact will be significant, according to Ben Quirk, CEO, Quirk Healthcare.
“Provider billing will be more expensive because of the level of specificity required,” he says. “I expect payers and Medicare to use the new data for further payment and quality tiering. And, of course, there will be glitches which will greatly increase AR days, so everyone needs to keep extra cash reserves on hand.”
“Ultimately, the providers who are on the ball with their preparation efforts will be the most successful, and those that didn’t start preparing yet will probably struggle more,” Laura Pazera, ICD-10 Program Manager, TriZetto Provider Solutions, says.
So many moving parts
Hickman emphasizes that ICD-10 implementation extends way beyond IT as a department and function and is more about “developing relationships with the whole spectrum of healthcare professionals” such that “the IT professionals will need to stretch outside of their comfort zone to get actively engaged with the users.”
Haugen agrees that integration is essential.
“ICD-10 is everyone’s responsibility,” she says. “It’s not just for the IT team. We always remind our clients how important it is to bring together leadership from all over the organization to become ICD-10 compliant. The IT team should understand this and support the effort to bring everyone to the table, including those physician champions who can build support for the changes needed.”
Don’t ignore business and clinical processes, Pazera says.
“We need to make sure that our IT teams are not working in a vacuum,” she says. “Since ICD codes are used for clinical documentation as well as billing, the transition also will impact business processes. One way providers can gauge the impact of ICD-10 is by performing testing to confirm that all their internal systems can accommodate the ICD-10 codes. They also should aim to conduct external testing with payers to confirm they can accept and return the claims, and to identify any shifts in reimbursement that may occur due to the new expanded ICD-10 code set.”
