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Experience. Integrity. Advocacy.

Was the ICD-10 Implementation Successful? Too Early to Judge

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With the implementation of ICD-10 more than three months behind us, early indications suggest a successful transition with only minor glitches. Most experts agree, however, that it’s too early to declare an overall ICD-10 victory.

Here are a few ICD-10 issues the industry continues to monitor.

Coder Productivity

Coder productivity remains a big issue in the transition to ICD-10. Early worst-case predictions indicated that productivity could drop by as much as 50 percent immediately after the transition, and at six months out could remain at 80 percent indefinitely. These estimates, reported by D’Arcy Guerin Gue, co-founder of Phoenix Health Systems, were based on a study of coder productivity at Humber River Regional Hospital, Ontario Canada, following Canada’s ICD-10 implementation.

In the first month following implementation, Himagine Solutions surveyed their clients each week and found productivity reductions of 30-45 percent reduction for inpatient coding and 20-40 percent for outpatient coding at Large Hospitals (over 250 beds). For Community Hospitals (under 250 beds), reductions for inpatient coding productivity were only 22-33 percent while for outpatient coding productivity, 35-40 percent.

With less than three months of ICD-10 data available, however, it’s difficult to judge where coder productivity currently sits or where it’s heading. Most experts agree that while productivity is on the rise after the initial implementation of ICD-10, it continues to be an important issue for coders to address.

In an earlier blog post, we laid out several strategies to help improve coder productivity. As you head into 2016, here are a few other ideas from AAPC Vice President of Strategic Development Rhonda Buckholtz:

  • Continue to learn the new code set especially with upcoming additions and changes later in 2016.
  • Increase coder skill levels through ongoing training.
  • Gain a better understanding of chronic conditions for the highest level of code assignment.

2016 Updates to ICD-10

Since 2011, ICD-9 and ICD-10 have been under a partial code freeze, with only “limited code updates to both the ICD-9-CM and ICD-10 code sets to capture new technologies and diseases.” With the code freeze set to expire, there is the potential for many new codes to be introduced this year.

“(There will be a) much larger number of new codes and other code modifications on Oct. 1, 2016,” according to AHIMA’s Sue Bowman, the Association’s senior director of coding policy and compliance.

Clinical Documentation Improvement

In a December ICD-10 Monitor article, both Buckholtz and Laurie Johnson, director of HIM consulting for Panacea Healthcare Solutions, indicated that clinical documentation is another ongoing issue in the transition to ICD-10.

Johnson says that deciding when clinical documentation is good enough slows down the revenue cycle. “For the clinical documentation specialists, the major challenges will be understanding when a query should be issued for documentation concerns,” she said.

As well, according to a December 1 Health Data Management article, many providers feel that the increased burden of documentation is taking away from their patient care. The article cited a November SERMO survey in which 1,249 physicians were polled about the extent to which “ICD-10 has taken away time from patients.” Two-thirds said yes. That number was down from a similar poll just 30 days after the ICD-10 implementation when “86 percent said it had negatively impacted patient care.”

“2016 should be used by providers as a year to improve documentation and reduce the use of ‘unspecified’ or ‘other’ codes,” suggested veteran ICD-10 observer Stanley Nachimson in that same ICD-10 Monitor piece.

Claims Delays and Denials

Of course, from the beginning providers have worried about claims delays and denials, and both continue to worry some industry experts. Bonnie Cassidy, senior director of HIM Innovation for Nuance Communications, Inc., suggests continual monitoring of DNFB (discharged not final billed) claims.

“It is a must to have dedicated staff monitoring DNFB on a daily basis. If this metric increases, make sure to take a closer look and evaluate the reasons causing the delay and holding up individual cases,” she writes in another ICD-10 Monitor article.

Also, claims denials continue to be a concern as more and more claims with ICD-10 codes are processed. Medical Economics interviewed healthcare consultant Elizabeth Woodcock about the potential for more denials ahead. “Woodcock is already hearing from practices starting to see a smattering of denials,” the article said. “For example, denials for preauthorization requests (particularly on imaging), a payer parking claims in ‘medical review,’ and one that denied services because the diagnosis didn’t support the need for the procedure. Right now this seems to only occur occasionally. But it is wise to expect denials from private payers to gradually increase throughout 2016—long before CMS’s 12-month grace period is over.”

The bottom line is that the ICD-10 implementation still has a lot of moving parts.

“It’s going to be a big story because it’s capital intense,” healthcare policy expert Paul Keckleytold Healthcare Finance News, “but it’s an inside baseball story. Unless an institution or plan fails to implement completely will it rise to a level of concern at the board level.”

— All rights reserved. For use or reprint in your blog, website, or publication, please contact us at cipromsmarketing@ciproms.com. Photo by Jenna via Flickr used with permission under the Creative Commons License.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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