Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

Top 8 ICD-10 Implementation Advice from Healthcare Experts

By Jacqueline DiChiara

- As continues to stay ahead of the ICD-10 implementation curve, many leading healthcare experts and leaders have offered a plethora of valuable advice, tips, and insightful opinions on a variety of subtopics related to ICD-10.

ICD-10 Implementation

Here is a brief collection of the top 8 pieces of ICD-10 advice, as told to via personal interviews with a variety of leading healthcare experts.

Pay special attention to metrics to prevent hiccups

“Physicians will need to closely track various metrics for their claims including pending claims, rejected claims, days in accounts receivable and payments,” states Robert M. Wah, MD, President of the American Medical Association (AMA). “Any issues will need to be addressed and reworked as early as possible to prevent a backlog of unprocessed claims and lack of reimbursement.”

“As an industry,” asserts Wah, “we need to ensure that the transition to ICD-10 is smooth and there are adequate contingency plans in place to prevent large-scale interruptions in claims processing and reimbursement.”

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Acknowledge what needs to be done; cheat a little

“Look at your organization to figure out where you’re using all of these codes. How can you plan for something if you don’t even know what you have to do?” states Jim Daley, Director, IT WEDI Past-chair and WEDI ICD-10 Workgroup Co-Chair of BlueCross BlueShield of South Carolina.

“Some of the doctors have cheat sheets,” adds Daley. “Those might be a good thing to address because it probably doesn’t take that much time anyway. But you don’t necessarily need your cheat sheets to be updated to get paid. Those are for internal usage. It may make it easier for you to do your operations but they’re indirectly involved in the revenue cycle.”

Daley adds it is vital to consider staffing needs and have a response plan formally enacted. “Who handles something if something looks different? Who do you call?” Daley asks. “Confirm who your contacts are. Do you have a payer contact? Do you have a clearinghouse contact? And plan for that actual cutover.”

Preparation and payer testing is key to avoid disruption

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“Recent studies have shown the cost for implementing ICD-10 for a small physician practice is a few thousand dollars, not the hundreds of thousands of dollars some people had projected in the past,” says Sue Bowman, MJ, RHIA, CCS, FAHIMA, Senior Director, Coding Policy and Compliance, of the American Health Information Management Association (AHIMA).

“If people get ready and they test with their payers and they’re on track on October 1, there’s no reason to expect that things won’t move smoothly forward, without significant disruption or lengthy payment delays. The key is making sure you’re prepared,” Bowman asserts.

Coders closely assisting physicians enhances documentation

“On an operational level, having a more granular code set like ICD-10 will enhance the ability to understand resource differences of services that are provided and also the ability to track new medical devices that are put into general categories that aren’t individually identified due to limitations in ICD-9,” states Chantal Worzala, MPA, PhD, the Director of Policy at the American Hospital Association (AHA).

Coders will likely need to more closely assist physicians to execute a greater long term understanding and awareness of needed documentation, maintains Worzala. Ongoing medical record evaluation and modification requires active data integration to allow for proper code assignment, she adds.

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Consider a holistic approach to ICD-10

“It’s critical to assume the worst and hope for the best to be appropriately prepared, says Ben Colton, Senior Manager at ECG Management Consultants and Leader of ECG’s revenue cycle practice. "I think it’s critical for value-based reimbursement and for ICD-10 to be considering those as initiatives across the greater health system enterprise rather than saying this is a hospital initiative or this is a physician-based initiative.”

Colton advices healthcare organizations to efficiently focus on how cost reduction can increase margins. “It’s not just looking for opportunities for cost reduction but also revenue enhancement,” he adds. “You need a holistic approach across the whole organization.”

Execute informed decisions intelligently

“When a clinician sees my three diagnosis codes map to five in a complex manner, they say, ‘I can’t run the report the same way. I have to make a new report,'” says Andrew Boyd, Physician and Assistant Professor of Biomedical and Health Information Sciences at the University of Illinois (UIC) at Chicago. “We want to make informed and intelligent decisions,” he adds.

Boyd asserts the industry needs to more clearly define the concept of diagnosis. “One of the concerns I have with value-based care tied to ICD-10 codes is based on prior experience with Switzerland. It took them five years in a nationwide basis to get to the same accuracy with their version of ICD-10 then they did with ICD-9,” he claims. ““Everyone in healthcare is smart. At the end of the day, can we do this? Yes.”

Identify what activity negatively impacts revenue cycle

“Everyone is expecting some lost productivity among all players of the healthcare industry,” states Karen England, MBA, CPC, Revenue Cycle Consultant at Ingenious Med. “However, the ability to identify activity which negatively impacts the revenue cycle is critical, considering no one is quite sure what that lost productivity will actually look like,” she adds.

“As reimbursement models continue to move toward bundled or capitated payments, providers must then fully utilize the concepts of specificity and improved documentation in order to receive appropriate payment for the care provided,” explains England. “At that time, providers with a solid grasp on ICD-10 coding and documentation will be able to optimize reimbursement for the services they perform.”

Have your IT and technical resources up and running

“The insurance payers will do the ‘best’ they can to be prepared. I say ‘best’ because the payers’ cash flow is not [influenced] when the ICD-10 changes are implemented,” states Douglas Kegler, CEO and Founder of CollaborateMD (CMD), Inc. “I hope the payers have their IT and technical resources ramped up and ready to fix their systems ASAP when they start denying and rejecting tens of thousands of valid claims.”

“Primary focus for 2015 is stressing to customers the impact ICD-10 will have on them financially and training them on reports and processes required to manage the denials and rejections once ICD-10 occurs,” Kegler maintains.


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