Policy & Regulation News

ICD-10 Mid-November Advice: Focus on Coding, EMRs, and KPIs

By Jacqueline DiChiara

- The healthcare world did not necessarily end with the ICD-10 switchover. Over 4.6 million daily claims throughout the month of October were reportedly processed with a 10 percent denial rate; 13 million claims were said to have been cleanly processed without a hitch; and 1 million first-attempt ICD-10 claims allegedly yielded a 99 percent success rate.

icd-10 implementation coding

Ken Bradberry, Chief Technology Officer for Xerox Commercial Healthcare, spoke with RevCycleIntelligence.com mere days before ICD-10 implementation kicked off last October 1, 2015 to offer his predictions and insights into where healthcare providers should best focus their energies.

This week, Bradberry chatted once more with RevCycleIntelligence.com to connect the dots between the past and the present regarding issues of ICD-10 readiness, the possibility of denials spikes, and whether or not ICD-10 is actually helping advance the healthcare industry for the better.

Popular ICD-10 predictions have mirrored a healthcare Y2K of sorts. Bradberry remembers when he was in the hospital the moment Y2K struck 15 years ago.

“We were in the hospital, it's midnight, and my entire IT department was all assembled and ready for the world to crash. We said, ‘Okay, when's it going to happen?’ It was kind of a nonevent. Some things happened overseas. But for the most part, it was pretty smooth.”

Says Bradberry about his ICD-10 experience thus far, "Over a period of time, we'll probably get some different stories of challenges of how the process didn't work as smoothly as hoped, usually with organizations that either have a poorly implemented EMR or, in some cases, just didn't bother to pay attention to ICD-10 at the level that they should have.”

“It helps that standards have been relaxed a bit. As you start to look for more detail and more specific ICD-10 codes, you might see a little bit more of a spike in rejections. I'm still waiting, watching, seeing what's going on, and talking to customers where I can, asking, ‘Hey, how's that ICD-10 thing going?’ Hopefully for them it's a nonissue because they've done their planning.”

Bradberry says many ICD-10 issues mirror those of ICD-9. Outcomes are a bit more predictable this time around, he says.

“The biggest challenge is we've got such a mix of different ways of paying for medical care. And between our insurance carriers and Medicare/Medicaid, it's such a wide mix versus a single payer, more government-controlled system, which you have a lot more control over," he maintains.

“From a quality and compliance perspective, it's really important that providers monitor that performance and set some standards from a KPI [key performance indicator] perspective,” says Bradberry.

“It’s so important that there is an oversight committee, a monitoring process that is watching to make sure that no one's just taking quick shortcuts, because it's with higher complexity. It’s going to require a little bit more work and more knowledge to get and take advantage of ICD-10.”

Dual coding challenges will create productivity issues, says Bradberry. Similarly, failure to code appropriately because someone is merely trying to save time or lacks training education is not the ICD-10 answer, he says.

“Down the road, when you realize, ‘Hey, wait a minute. I'm supposed to have more specific, more detailed codes here, and all I have is a bunch of unspecifieds.’ That could come back to haunt the health system in a few different ways from quality of care to accuracy in the billing, to even a liability perspective.”

Within the next three to six months, Bradberry says it will be important to keep an eye out for new information about claims denials from the Centers for Medicare & Medicaid Services (CMS).

“It will be interesting to see how many 'unspecifieds' are rejected as well as the codes that were accepted but simply weren't accurate or not detailed,” says Bradberry.

Even those who are well prepared still need to be monitoring and ensuring coding is appropriate, he says, adding that the ICD-9 mindset needs to diminish if it has not already.

“It's going to be important to pay really close attention, because a lot of the large systems were prepared for this. And if they’re using ICD-10 appropriately, it should be a nonissue,” he says.

Bradberry says he’s heard passionate arguments from both sides about whether or not ICD-10 will help advance healthcare or create more accurate diagnoses.

“If you're following the guidelines like you should be, and you're managing and complying with requirements, are you taking full advantage of that level of detail? It’s not going to come automatically with a conversion to ICD-10,” he says.

“But while you're doing this, you're adding additional information that could be truly useful in everything from population health management to just your own core measures and ensuring that you're operating as a value-driven healthcare organization. It's just one component of several different areas that needs to be considered when you're looking to improve quality."

“We've finally made that jump to ICD-10. Now, what are we going to do with it? What are health systems going to do to improve their quality and enhance their services? That's really up to that individual health system as to how sophisticated they're going to be in using that additional data that they could use to improve their quality of service,” he says.

“Is it going to help health care industry? Possibly, if it's utilized properly. If not, then it's just another coding method they're using that hopefully is functioning appropriately.”

Bradberry says ICD-10 has truly enhanced software and is continuously advancing service quality.

“Everything that comes with that is really going to be how it's utilized in what tools you deploy and what service provider you use to help you get there, whether internal or third party,” he states.

“How well your EMRs are deployed is also very important, because it's a 'garbage-in, garbage-out' kind of scenario,” he adds. “You have to be very mindful of the whole delivery system. ICD-10 is just one part of that.”