As expected, ICD-10 caused administrative headaches for healthcare providers across the United States. This was expected to be especially true for small practices and hospitals that were caught unprepared for the magnitude of transitioning to the 10th version of the International Classification of Diseases, now required by the U.S. Centers for Medicare and Medicaid Services for all Health Insurance Portability and Accountability Act-compliant healthcare providers.
Even for the best-prepared ambulatory surgery centers and other providers that spent months updating their systems, training staff and running drills, disruptions will remain inevitable into 2016. After all, this is the first coding switch in more than three decades, and business office staff — many of whom are too young to remember the switch to ICD-9 — now have to contend with about 50,000 additional codes. The financial stakes also are higher today, as the business of healthcare continues to change dramatically — and will continue to do so. What was once a simple coding mistake can now cause serious financial disruptions to a provider, especially when high-dollar surgical cases are involved.
Federal healthcare regulators have recognized these challenges. In July, CMS announced it would provide the medical community with a temporary coding error reprieve for the first 12 months after the Oct. 1 deadline, provided that the appropriate family code is used. With private payers not issuing similar guidance, however, providers must remain vigilant in reducing errors, ensuring compliance and maximize reimbursements, especially in these six areas:
In the run-up to Oct. 1, many large payers appeared to have made a significant push to ensure the necessary ICD-10 updates were in place — or at least planned to do so. According to a Workgroup for Electronic Data Interchange survey release July 30, “nearly three-quarters have begun or completed external testing, representing a significant increase from one-half in the February survey.”
Specifically, an overwhelming majority of payers — seven out of eight — reported that their ICD-10-related internal business process design and development is “complete or nearly complete.” More than 80 percent of the payers interviewed for the survey had started internal testing, and about 40 percent had completed this step, according to WEDI.
These impressive ICD-10 readiness efforts likely skewed primarily to larger payers that have big enough budgets to absorb such expensive preparation efforts. In WEDI’s July survey, self-described unprepared payers cited “competing internal priorities”, “provider readiness” and “uncertainty around further delays” as the top three reasons why their efforts have lagged. This disparity suggests that the most unprepared payers tended to be smaller organizations operating in less populated states, where the provider community, too, may have been caught flatfooted because of scant resources and ICD-10 education.
It may be months, however, before definitive trend lines emerge answering the what, where and why certain stakeholders were or were not prepared. In the meantime, accounts receivable staff can play an enormous role in tracking ongoing issues with payers, educating coders and working with front office staff to identify problem areas before they become systemic.
For nearly all U.S. surgical facilities and medical practices, charts, ledgers and other physical recordkeeping will soon be obsolete. Today, virtually every aspect of a practice or facility is — or will soon be — digitized. Before Oct. 1, ASCs were advised to aggressively monitor updates to their software systems, so that ICD-10-related changes were incorporated. This shouldn’t end after the deadline, as vendors are expected to continue to release ICD-related updates for the foreseeable future.
Alongside cash flow, productivity is expected to be a primary casualty of the ICD-10 transition — slowing down coding staff by as much as 50 percent, according to a recent time study published in the Perspectives in Health Information Management.
Eliminating as many manual processes as possible during the transition can cut down on the productivity loss. Process improvement tools such as Six Sigma provide a deliberate methodology for assessing and improving repetitive business office tasks for healthcare providers. Popularized by GE decades ago, Six Sigma can lower labor costs, reduce billing and coding errors, and improve customer service for healthcare organizations by refining existing processes using the following five steps: define, measure, analyze, improve and control.
ICD-10 is often mistakenly identified as a pure coding change. In fact, it’s a revenue cycle management change that affects every aspect of a modern day ASC or physician practice. Continually communicating with all staff and physicians, educating them about denied claims, and revamping processes and procedures is an essential part of preventing repeated errors.
At least through Jan. 1, daily all-staff meetings provide an opportunity for the various departments of a surgical facility to share their experiences and solicit feedback about ICD-10-related issues. After Oct. 1, A/R will begin receiving information from payers at least as frequently, so convening quick staff huddles in the morning can make sure information from previous days sticks.
Clearinghouses and other healthcare vendors appeared universally well-prepared for the Oct. 1 deadline, according to the July 30 WEDI survey. All of the vendors interviewed indicated that they had started developing their ICD-10 solutions, and 90 percent were at least halfway done.
Continuing to work with clearinghouses after the deadline should remain a priority. Many of these firms will continue to provide testing opportunities after Oct. 1, which allows providers a foolproof method for determining if they have a clear path.
With clinical matters taking a priority, the ICD-10 learning curve is expected to be steepest for physicians. All ASCs and physician practices should assign a dedicated resource to review physician documentation, identify areas for improvement, provide the necessary feedback and limit the use of unspecified codes.
Many software providers updated their systems ahead of the deadline to include prompts that ask physicians more detailed questions when they’re entering patient information into the interface. Still, some facilities also may need to develop new EHR query forms that can prompt physicians towards the correct codes.
In its July 30 survey, WEDI identified physicians as the least prepared in the immediate months preceding the deadline, while concluding that the remaining healthcare industry stakeholders — vendors and payers — are “expected to be ready by October 1.”
Were they right? Only the coming months will tell.
This guest column is the final installment of a three-part series on ICD-10 readiness, troubleshooting, and solutions.
October 14, 2015
Ref. Becker’s Healthcare
This post was first published October 14, 2015 and was updated July 29, 2020.