Countdown to ICD-10 Implementation: 1 Day Until Go-Live
By - One day remains until ICD-10 implementation begins. Rumors of a possible government shutdown are swirling. If a lack of federal budget agreement sparks a government shutdown on October 1, 2015, the ICD-10 transition will continue as planned, reported HealthITInteroperability.com.
“In the event of a shutdown, we will continue – and I want to be clear on this – to pay claims,” said Patrick H. Conway, MD, MSc, Principal Deputy Administrator with the The Centers for Medicare & Medicaid Services, to reporters last week during a conference call. “We will continue to implement the ICD transition,” Conway stated.
ICD-10 brings about a great deal of challenges. Healthcare providers will be changing their documentation practices. Revenue cycles will perhaps need to be closely monitored to ensure success. Inaccurate coding may lead to financial snags. Education efforts will hopefully continue as knowledge gaps are addressed.
To offer clarity on such points, Ken Bradberry, Chief Technology Officer for Xerox Commercial Healthcare, chatted this week with RevCycleIntelligence.com to explain his healthcare predictions regarding what may come next once October strikes.
RevCycleIntelligence.com: What are the primary challenges healthcare providers will face come October 1?
Ken Bradberry: ICD-9 has been the standard for coding since 1979. The transition to ICD-10 is a major upgrade to an antiquated coding system. This transition will increase the number of diagnostic codes to 69K, in an effort to better capture the specificity and complexity of illnesses and injuries with more accurate descriptions.
For providers, this will require a process change in documentation practices. It can also mean a deeper assessment of the patient in order to achieve the level of specificity needed for clinical documentation. For example, a femur fracture with ICD-9 required only 16 codes, but with ICD-10, that increases to 1,530 required codes. With this dramatic change, it's critical that providers do not code improper or incomplete ICD-10 codes, as this could lead to claims being denied and delays in service to the patient.
In some cases, providers will be using a dual coding system during the transition period, which can lead to an increase in human error. It's important for providers to stay on top of the new ICD-10 codes to ensure that proper reimbursements are made.
Role-based training can help alleviate these challenges. In most cases, doctors and nurses need only learn a subset of the new codes based on their roles, the types of patients they see, etc. By training staff only on the codes they need on a day-to-day basis, healthcare providers can reduce errors and also staff frustration.
RevCycleIntelligence.com: When will we know what the impact of ICD-10 really is?
KB: The most immediate gauge of ICD-10 success will be financial, with revenue cycles remaining strong and even increasing due to fewer rejected claims and lower administrative costs, and because ICD-10 enables the ability to accommodate new medical procedures and innovations that might have been lumped in with old ICD-9 codes. As for clinical quality of service, the influence on core measures that healthcare providers report on will be longer term. How ICD-10 impacts readmission rates and other quality measures will take longer to measure and report. This is why the proper implementation of ICD-10 is so critical to the success of the healthcare provider, the payer, and for overall patient satisfaction.
RevCycleIntelligence.com: What are the biggest hiccups to anticipate?
KB: As with any major technological implementation, bumps will occur in the first weeks or even months. When the switch flips, every healthcare provider and payer across the country will be expected to immediately begin communicating to each other in a new language.
It is a reality that there will be some miscommunications in the form of inaccurate codes or shortcuts taken to bypass the increased complexity that ICD-10 brings to the continuum of care. This may lead to patients being unable to schedule procedures in a timely fashion or patients receiving incorrect bills from providers and/or health insurance payers.
RevCycleIntelligence.com: How will the updating of antiquated codes and a decades old system help improve and advance the healthcare industry?
KB: ICD-9 is over 30 years old and has not kept pace with the dramatic advancements in the healthcare industry. It can't accurately describe the diagnoses and medical procedures today. For example, medical techniques that are common today – like laser and laparoscopic surgeries – were not performed at the time ICD-9 was implemented.
ICD-10 is particularly important since it will provide us with more specificity in describing a diagnosis and treatment plan and far better data for evaluating and improving the quality of patient care, leading to stronger population health management and an increased ability to understand complications.
RevCycleIntelligence.com: How can the healthcare industry best prepare for the switch? Do you have any specific advice for the healthcare industry?
KB: Leadership is an important piece of this puzzle. In order to ensure a smooth transition, healthcare organizations need a strong leader to lead the charge and make ICD-10 a priority. It's also critical that all stakeholders choose a partner who can successfully lead them through the complexity of transitioning to ICD-10. Providers are able to seek temporary help with coding during the transition to ICD-10, if needed.
RevCycleIntelligence.com: Other key areas of ICD-10 importance to consider?
KB: This transition has hospital-wide impact. It’s important to inform and educate medical billers, schedulers, clinicians, managers, administrators, and other staff members on the ICD-10 transition. Specificity is the key to ensuring proper clinical documentation and to timely payment of services. Lack of attention to detail can trigger claims reviews, delays in payment, and delays in services to the patient.
