Policy & Regulation News

3 More ICD-10 Implementation Tips from Healthcare Experts

By Jacqueline DiChiara

- ICD-10 implementation is almost here with October 1, 2015 just around the bend. As talk of delays, coding confusions, claims disruptions, and the like continuously reverberate around the healthcare industry, the ICD-10 clock nonetheless ticks onwards. Continuing now with a second part of ICD-10 suggestions, here is yet another compiled collection of top recommendations and educational insights gathered from numerous personal interviews from healthcare experts with RevCycleIntelligence.com.

ICD-10 implementation delay codes claims

Consider going back to the future of claims management

Said Pam Jodock, HIMSS Senior Director of Health Business Solutions, it is increasingly imperative to understand your annual trending patterns for pended claims. Stated Jodock:

“Know what your level of pended claims is going into October 1, 2015. Understand your trending over the last twelve months. Do you see a spike in pended claims at a certain time of year? Know what that history is within your organization and then have a process in place for tracking that same activity under ICD-10.”

“If you see abnormalities in your reports after October 1, 2015, work with the appropriate parties to get those issues resolved quickly.”

“My hope is that as we approach October 1, 2015 all provider organizations will have spent the time to test, train and prepare for the transition to the new code sets, and that they will have developed an agreement with their primary payers that will protect their revenue stream if the transition to ICD-10 has an initially severe negative revenue impact.”

Accept ICD-10 changes nothing about how to practice medicine

Said Michael Clark, Chief Operating Officer at Evariant, the best and brightest physicians will soon be trapped amidst the burden of documentation. They will continue to ask themselves, said Clark, “What’s in it for me?” ICD-10 does not change how physicians practice medicine, stated Clark. However, it does change how each encounter and treatment is billed and coding. What is expected of physicians will take time to master, he said.

“Over time, years and generations of physicians will learn what to document, and then they’re back to the same other issue of, "How can I document to a great level of specificity, and not lose productivity?" Process and technology have to address the challenge. It’s a vicious burden of change on all stakeholders, each having attempted to solve the problem from their compartmentalized view – not that there haven’t been millions spent preparing.”

“At the end of the day, the heavy burden is on the physician with little to no meaningful immediate benefit to spend time documenting. He or she knows what the patient’s condition is and in a referral situation – when done effectively – the receiving physician is well aware of specificity through other verbal and non-verbal conveyance. With ICD-10, physicians are the ones treating the patient and the expectation is they need to document a greater level of specificity for appropriate care, professional appropriate reimbursement, and medical/legal/regulatory compliance consistent with the expanding ICD-10 code set, and that takes time.”

Expect an (artificially inflated) recovery period come Nov.

Stated Cecil Bohannan, Jr, Delivery Manager, Advisory Services, CTG Health Solutions, as October transitions into November, it is possible many patients will still be receiving needed healthcare services. But some providers will simply be unable to bill accordingly as it feasible to expect a spike in Incurred But Not Reported (IBNR) claims.

“It will artificially look like the costs to provide healthcare coverage to members are going down when, in fact, the real issue is you just don't know what the cost is because the providers haven't been able to send you a claim.” 

“You'll have a recovery period, as well. It could be that in the fourth quarter of 2015 it is going to look like your medical costs are down, but in the first quarter of 2015, once everyone figures out how to get their claims paid, suddenly medical costs could look artificially like they’re going up because you've got all those old claims being paid a quarter late.”

“People are saying we can't trust the first-quarter's data because we just don't know what it is. Most payers that I've worked with, many providers, and even CMS said they’ll collect data for a year before they make any kind of financial or medical decision based on the data. Yes, we're going to be getting all this great data early, but there will not be a lot of decision making based on the data in the first year.”