Preparing for success under the looming ICD-10 deadline
The October 1, 2014 deadline for healthcare providers to change to ICD-10 coding ushers in the greatest medical coding enhancement in 30 years. The challenge to providers is not just how to seamlessly make the transition, but also how to realize the benefits of ICD-10 from day one.
Healthcare providers are facing enormous changes to multiple systems and processes in order to achieve compliance by the deadline. In fact, a December 2012 letter from the American Medical Association to the Centers for Medicare and Medicaid Services estimated that costs for changing to ICD-10 could run as high as $2.7 million for large practices. Part of the transition costs could stem from productivity decreases of coders as well as physicians.
Companies that have not yet begun the process of preparing for this enormous transition are already behind, and may not see the benefits of the new system as quickly as those organizations that started early.
The first step to prepare for this transition is to extensively evaluate the current processes via readiness assessments and ICD-10 gap analyses. The ultimate goal of these evaluations is to ensure that operational effectiveness is maximized throughout the transition. The results of these analyses will provide recommendations to assist with problem areas, such as systems and applications, vendor preparedness, technology requirements, personnel training and workflow processes. Organizations must then create a plan to guarantee compatibility with ICD-10 systems and enhance the efficiency of current billing and claims operations.
The new ICD-10 system has the potential to provide targeted insights that could drive improved patient outcomes, which, in turn can benefit the revenue stream, offer greater clarity to payers, and reduce denials and claims appeals.
Another element that organizations must implement in order to gain advantage during this overhaul is better documentation support. Without appropriate physician documentation, organizations may open themselves to increased claim rejections, denials, and appeals. Unfortunately, enacting this greater level of specificity also requires more granular documentation from doctors as well as an understanding of anatomy, physiology, pharmacology and new terminology by coders. For example, under ICD-9, there may be just one code for a broken bone in the leg; however, under ICD-10, there may be a separate code for each bone on each leg and there may be separate codes to indicate the type of break. In order to meet the new specificity required by ICD-10, smart organizations already have started training plans to better prepare staff to maximize the new documentation process.
Mastering the “art of documentation” now, especially the specificity requirements necessary to drive accurate coding, only will lead to a better understanding of health outcomes and increased payment accuracy for organizations. More accurate documentation, ultimately, translates to prompt reimbursements and fewer claim denials and appeals.
Sometimes transitioning to this complex new coding system may require outside help and enhanced resources. The new ICD-10 system has nearly five times the number of codes as its predecessor, which will require extensive training in order for internal coders to become proficient. Testing on live documents and enacting minimum proficiency standards are necessary to prevent errors and lost productivity that could threaten patient outcomes or revenue streams.
A December 2012 report by Klas Research found that 65% of providers are consulting external professional organizations to help them successfully transition to the new coding system. This external resource may greatly benefit an organization, particularly if it has international experience. Organizations can lean on the international experience of firms that already have helped companies in other countries through this challenging migration.
Finally, providers should institute ongoing quality reviews to protect both the quality of patient care as well as the revenue life cycle before and after the transition. The key components of these checkpoints include, assessment of information flow measurement of current readiness plans against benchmarks and creating and maintaining process effectiveness. This allows organizations to continually catch irregularities and adjust early.
The transition to the new ICD-10 system is certainly daunting to many organizations – both large and small. However, this transition offers an opportunity to organizations that are willing to plan strategically to capitalize on the advantages built into the new ICD-10 system to enhance patient care and bolster revenue cycles.
Damandeep Kochhar is the senior vice president at Genpact.