ICD-10 storm – the challenges and its solutions

Dec. 30, 2013

October 1, 2014 is the deadline for implementing the ICD-10 coding, according to the U.S Centers for Medicare and Medicaid services (CMS). The transition from ICD 9 to ICD-10 is likely to impact almost every part of healthcare industry, right from the providers to payers. According to ICD-10 readiness survey conducted by the Workgroup for Electronic Data Interchange, a large part of the professional community has little or no awareness of the federal mandate. Merely half of the providers and about 60 percent of health plans have completed an impact assessment, and just one of three payers is currently conducting external testing. The dismal findings show the lack of preparedness in the healthcare industry as it continues to struggle with the requirements of the switch.

WEDI Chairman Jim Daley in a letter addressed to CMS, wrote:

“Based on the survey results, it is clear the industry continues to make slow progress, but not the amount of progress that is needed for a smooth transition. People are finding this is bigger than they expect. They're finding that more time is needed”

Top 3 ICD-10 Challenges The Cost of Lost Productivity Decrease in productivity (at least for a short span of time) is inevitable in any profession when workers are in training or learning a new skill. Same goes for coders, especially for inpatient coders, as they have to learn two new code sets: ICD-10-CM for diagnosis coding and ICD-10-PCS for procedure reporting. As a result, accurately documenting and coding each patient encounter will take longer by the coders, resulting in cost of lost productivity.

Increase in Documentation

With ICD-10 approaching, the industry focus is turning more towards Clinical Documentation Improvement (CDI). The ICD-10 code set requires a higher level of specificity as compared to the current ICD-9 standard. ICD-10 will restructure the clinical documentation practices that have been widely accepted for more than three decades. Clinical documentation is needed to select the appropriate ICD-10 code, and new terminology must be used to document patient care information and support both the diagnosis reporting and the medical necessity for the service provided. Taking steps to improve documentation will be foundational in helping the practice get paid faster, experience fewer delays and denials during the changeover.

Training is a Challenge

For a practice to understand how ICD-10 is structured and applied, a lot depends on the size and the experience of the staff in medical coding, which in return will decide the hours of training required. Canada embraced ICD-10 between 2001 and 2006. The data indicates, post ICD-10 implementation, there was a decline in productivity by 10 percent in the year before and the year after the implementation. It took an average of 6 months for most healthcare practices to return to an acceptable productivity level. Training, slower processing time, increased inquiries from coders, and billing inquiries from payers, all contributed to hours of lost productivity.

Overcoming ICD-10 Challenges

Switching to ICD-10 CM/PCS is no cake walk for the healthcare organizations. The root of the issue goes much deeper than merely upgrading coding and billing staff acumen. The major step in preparing for the transition is to create a team within the practice to discuss about ICD-10 and determine its impact. After the initial discussion, a team should be assigned to develop a timetable and implementation plan.

Suggestions to overcome ICD-10 implementation crisis:

  • End-to-end ICD-10 Testing plays a crucial role in preparedness for implementation of ICD-10
  • Clinical Documentation Improvement (CDI) and its strategic planning
  • Identifying the errors and gaps in clinical documentation and bring a solution
  • Computer Assisted Coding (CAC) can improve overall department efficiency, documentation quality and coding accuracy
  • Technology and software advancement to simplify the ICD-10 transition process by optimizing the reimbursement
  • Training certified coders on ICD-10
  • Supporting the remediation efforts by cross maps beyond GEMs
  • Streamlining ICD-10 Data analysis to make business ready to take on challenges
  • Study ICD-10 impact analytics

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