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Recovering from ICD-10 Delay Requires Planning and Engagement

By Jennifer Bresnick

- The ICD-10 delay may have knocked the wind out of a number of healthcare organizations who had been preparing for an October 1, 2014 deadline, but now that a new date has been set for 2015, it’s time to start picking up the pieces and getting back on track.  With less than a year to go, the majority of providers still have a great deal of work to do in order to prepare for the new code set, and must retool their roadmaps to meet the challenges ahead.

From reinvesting in infrastructure to mitigating the potential financial impacts of denied claims, how can providers ensure that they are ready for the ICD-10 switch?  Summer Scott Humphreys, Executive Consultant for Beacon Partners, sat down with EHRintelligence to discuss some of the actionable steps providers should be taking as the clock ticks down to October 1, 2015.

What does the preparedness landscape look like to you at the moment?

There are a variety of preparedness stages depending on the status of a given healthcare organization.  Some systems were very prepared for ICD-10, and so the delay was a big blow because they felt they were ready.  They did all the testing and went through the dual coding.  They really prepared all of their systems, and now it’s on hold, when they were ready to go.

Then you have the other side with those people who are saying, “Well, is it really going to happen this year?  We’re going to hold off and wait and see.”  Those facilities are at greater risk.  In terms of the clients we’ve worked with, most of them that have actually gotten into ICD-10 planning have found that there really is a lot of work to do, and even with the delay, those organizations that were diligently preparing have found that they can take advantage of the delay to really be ready.

READ MORE: Return of Annual Updates to ICD-10 Code Set Begin Oct. 1

I would say that your larger-scale health care systems have been planning for this for a long time, and then as you get down to your smaller providers or your rural areas, they’re less prepared.  It takes time, and it’s energy and capital expended, and I don’t think they have the ability to put as much effort into it.

What are some actionable steps that providers can take to prepare themselves during the delay?

First of all is ensuring that IT systems are upgraded and that a thorough testing of internal systems is conducted to make sure everything is working the way that the vendor states they should.  Not only that, but everything also needs to work the way the organization wants it to, as the way the vendor says it should work might not be ideal for an organization’s workflow.  So an organization might need to make some adjustments here or there.

Another area is working on dual coding and finding the valuable lessons.   Getting practice for coders is so important, because on the inpatient side it’s anticipated that productivity may decline by 40-60 percent.  Make sure communication channels are opened so that coders can actually work with each other to understand the consistent application of these codes.  There’s a lot that’s open to interpretation and an organization needs to be consistent about the decisions made.

What are some of the financial implications of being unprepared for ICD-10?

READ MORE: CMS Issues First Claims Metrics Since ICD-10 Implementation

There is a potential financial impact with ICD-10 when it comes to DRG shifts, and that can be seen through conducting a financial impact analysis.  An organization can do this by analyzing a large set of claims, translating them from ICD-9 to ICD-10 and regrouping the ICD-10-coded claims.   That will help identify DRG shifts and the areas that are at greatest risk in terms of the organization’s service lines.

Organizations sending out claims with a high percentage of unspecified codes may be at risk in ICD-10 for potential payer denials if they continue to send out claims with unspecified codes when there was a potential to assign a more specific diagnosis.

Some executives haven’t quite gotten the concept yet that ICD-10 isn’t focused in just one or two areas.  These codes really live everywhere in an organization.  A thorough inventory needs to be completed because if an organization has missed something and it becomes a cog in the wheel, and then it ends up in claims not going through, that can result in a major cash flow problem.

With ICD-10, it’s anticipated that days in accounts receivable may go up by 20 to 40 percent.  Denials may increase.  I would suggest having a strong revenue cycle team in place that actually starts looking at denials now as problem areas now are just going to become larger with ICD-10. Focusing on those denials by provider, by coder, by payer and figuring out why they’re happening is going to help an organization prepare for ICD-10.

What are the challenges when it comes to getting providers engaged with ICD-10?

READ MORE: CMS Addresses the Isolated Issues in ICD-10 Implementation

Some of our clients have found that provider engagement is the most challenging part of the entire ICD-10 process.  A physician will say, “You know, I take care of the patient.  I provide good care, and I feel like I’m doing the job.  The patient leaves the hospital.  He’s well.  Why do I need to change my documentation?”  Engagement is about getting providers to understand that ICD-10 really is a quality initiative.  It’s about getting that coded data to accurately reflect the truth: the severity of illness and risk of mortality of a patient.

Unplanned readmission and death rates are publicly available, and all these quality metrics are increasingly being tracked.  If a provider’s documentation isn’t an indicator of truly what happened to that patient, then the organization scores are going to suffer.  The physician’s scores are going to suffer.  Part of their reputation may be at stake if they don’t start documenting better.

And when they do, it’s really a win-win that the data is better.  An organization has a better accounting of patient visits.  If the patient comes back into the hospital, the organization has that coded record that’s more accurately reflective of what happened, and perhaps the patient can be treated better the next time while the organization is getting paid appropriately.  It’s so important to communicate to the provider that everyone wins when your data is the best it can be.

Will providers be able to recover from the lost momentum produced by the delay and get ready by October 1, 2015?

It will be interesting for a lot of these organizations that have put ICD-10 on the shelf, because now they have to start over again. Given a lot of changes in their IT systems in the past nine months since they’ve shelved the project, there are new versions that they’ve upgraded to that need to be checked.   Is this new version correct?  Can it accept the codes?  Does it work for the test system?

A lot of organizations have acquired new software in that time, and they’re going to have to comb through that.  So I think that those organizations that chose to shelve it are going to find that they need to redo some of their work to ensure that they suddenly didn’t miss something again.  So it’s a re-review of that gap analysis and project plan to ensure that everything has been addressed.

There is that silver lining of having extra time, however.  Those organizations that have pushed through the uncertainty of the delay have found that by continuing to prepare and look at their CDI efforts, revenue cycle optimization, and by doing dual coding, their bottom line can really benefit right now.  There are also benefits to continuing that preparation because a lot of these activities can help an organization now.  Documenting better in ICD-9 can improve an organization’s case mix index even before we move to ICD-10.

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