ICD-10 is around the corner, for real this time

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Elizabeth Newman
Elizabeth Newman

There's a looming massive report on all the hospital readmissions data in your area and the strategic plan your facility needs to pursue. It involves talking to lots of employees, gathering data, doing statistics and the actual writing, not to mention proofreading, and having your boss sign off on it. It's due Oct. 15.

You haven't started on this project.

Then, lo and behold! Due to unforeseen circumstances, you have been given until Nov. 15 to finish this report.

Conventional wisdom says that you breathe a sigh of relief and diligently start plugging away. But what's more likely is that you are going to wait another month to start working on this report.

In broad strokes, that's how the ICD-10 delay has played out in healthcare. Once the Oct. 1, 2014, deadline was pushed back a year, everyone breathed a sigh of relief and went back to their emergencies.

“Delays just breed procrastination,” says Josh Berman, Director, Business Analytics & ICD-10 Lead for RelayHealth Financial. In March, he observed that there were tens of thousands of test claims from payers rolling in, which dropped by about 25% by the end of summer, a trend that should be reversed. While there's some legitimacy to delaying staff training in order for the material to be fresh, there are at least some providers who are holding off in hopes that ICD-10 will be delayed again.

Assuming it's not, it's worth remembering that even in ICD-9, healthcare entities “are not really all that good at coding,” Berman notes. The good news is despite the focus on the 141,000 new codes that are coming, there's a subset that is critically important to each facility. A hospital may need a few thousand, but long-term care may be able to focus on nailing down between 50 to 100 codes.

“Don't worry about the giant number,” Berman advises.

No matter when ICD-10 arrives — and it's worth remembering we've had our current version for longer than I've been alive — what long-term care and hospitals share is that they need better and better-paid coders. It's traditionally a group of people that is underpaid and undervalued. Once upon a time, the coders were seen as making widgets, Berman explains. Now that group has to not only understand the nuances of what they are doing, but to understand the meaning of their jobs in a larger context. For example: A bad code at a nursing home could lead to an overpayment, which could lead to a RAC or other government audit. Submitting the correct code doesn't just lie with the coder, either.

“Now you're asking the widget-makers to be more specialized,” Berman says. “You have to make sure coders can code correctly and that doctors are writing specific-enough notes so that they can code correctly.”

While payers will test only 10 to 20 providers, meaning long-term care will likely be left out of further testing, what executives can do is look at their partnerships with payers, including asking for transparency, Berman says. CMS also offers videos and other resources in preparing. Providers also should talk to their vendors.

And don't count on another reprieve.

Elizabeth Newman is Senior Editor at McKnight's. Follow her @TigerELN.

Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.