Is ‘Moderate’ ICD-10 Implementation Success Still a Success?
By - What does ICD-10 implementation success mean for your healthcare practice come October 1, 2015? How will your healthcare practice be affected? Perhaps success is nothing more than the simple realization you are not in the red when it comes to revenue cycle management. Or, is the definition of ICD-10 implementation success a tad more elaborate?
As a follow-up to an earlier RevCycleIntelligence.com interview about how Accountable Care Organizations (ACOs) are driving patient behavior, Bruce Hallowell, Managing Director at Navigant, discusses the greater implications surrounding the possibly problematic upcoming ICD-10 implementation deadline and its impact on reimbursement. A focus on benchmarks and comparing apples to apples is key to ICD-10 implementation success, says Hallowell. Dispelling commonly accepted ICD-10 myths is also an essential aspect of revenue cycle success within the healthcare industry, he adds.
RevCycleIntelligence.com: What are the most common ICD-10 myths or misconceptions floating around the healthcare industry?
BH: What everybody’s ignoring is that we went through this whole plethora of meaningful use and installing new computer systems. Pretty much everybody has an EHR because they thought they were going to get rich, or get some excess money for it.
They key to ICD-10 has nothing to do with the code itself. The problems with ICD-10 have nothing to do with the code itself. For me to code in ICD-10, I need a certain level of documentation in a system. Coders code what they see. Yes, I’m going to this extraordinary detailed coding which means I need to get to the extraordinary detail of the documentation. The biggest myth we have is nobody’s paying attention to the documentation.
If I ignore where the documentation is coming from – the clinicians and physicians – I’m not going to be able to code and it’s not going to be able to make a difference. The biggest misconception I know that’s floating around the industry: if you train your coders in your EHR systems, you’re going to be fine. They’re not. It’s not going to happen.
RCI.com: What does ICD-10 implementation success actually mean? How can it be achieved? Is moderate ICD-10 implementation success still considered a success?
BH: Success is a moderate answer, that my reimbursement and my quality indicators are no worse than they are today. Coupled success, which means my denials didn’t go up, my reimbursement didn’t go down. If I can get through this major hurdle by causing no harm to myself clinically from an outcome standpoint or financially from a denial standpoint, I would consider that a success.
There are certain breakage points that are going to happen. Yes, we need to have an IT remediation to make sure that the code goes through the system. We also need to make sure that our coders and clinicians are educated. But to be really successful what I need to do is make sure my managed care contracts are updated to clearly state what ICD-10 codes are going to be reimbursed by what way. I need to make sure all my clinical documentation is reviewed and brought to an ICD-10 standard.
RCI.com: What is the healthcare industry collectively forgetting about ICD-10 implementation? What is the key to ICD-10 success?
BH: The last thing you need to do is at least recode a year’s worth of ICD-9 so I can compare and mitigate my risk on a daily, weekly, or monthly basis. The problem we had is most people aren’t doing that. I can’t compare the two. If I don’t have a year’s worth of data prior to October, what am I going to compare against? I don’t know if I’m hurting myself or helping myself.
They also forget the idea that not everybody is going to ICD-10. So I’m going to have to dual code anyway. I could take an ICD-10 to ICD-9. I just can’t take an ICD-9 to an ICD-10. People are saying, ‘I’m going to take my ICD-10s and make them ICD-9s and that’s how I’m going to do my comparisons.’ It’s not detailed enough. They can’t.
Every comparison has to be done at the lowest common denominator. If they don’t do that, they’re going to leave themselves with such an open-risk, they’re not going to be able to figure out what’s going on. The key to success is to be able to run benchmarks for mitigation.
