Best Practices for Healthcare Success with ICD-10
The new system, designed to deliver a more specific and accurate mapping of medical diagnoses, is expected to drive innovation and produce significant savings. In fact, the Dept. of Health and Human Services (HHS) says ICD-10 will strip up to $15 billion unnecessary costs from the healthcare system over 15 years. The value will be realized via greater claims processing accuracy, according to HHS, which will cut down on the number of rejections that are often the result of incomplete documentation and duplicate submissions.
Of course, that is after the kinks get worked out. In the near term, ICD-10 will be a distraction. After all, a conversion of this magnitude—an increase in the number of diagnosis codes, from about 14,000 to nearly 70,000—has never before been accomplished. Not only will it impact staff productivity, it’s projected to disrupt cash flow. Experts say that practices in particular should have a three-to-six month reserve to cover the necessities, such as medical supplies, payroll and rent, to keep their business operational.
Problems will most likely stem from a higher number of claim rejections off the bat as physicians and learn to document with greater specificity and coders adjust to the nuances of the new standard. But there are things that providers can do minimize the impact that 1CD-10 has on operations.
Education and training
One of the easiest and most impactful activities organizations can do to in relation to ICD-10 is to bone up on how ICD-10 will affect coding practices. Providers can immediately begin analyzing how their most common ICD-9 codes will translate to ICD-10 and the additional specificity they will need to provide in order to process accurate claims. Meanwhile, clinicians can prepare ahead of time by learning how their EHRs respond to the new coding demands. It may require organizations to make some significant investments in training; however, that money will be easily recovered by providers that navigate with transition with as minimal disruption to cash flow as possible.
EHR System Readiness
Healthcare providers shouldn’t be afraid to press their vendors about their readiness for ICD-10. At the very least, they must find out if they will even have access to a version of an EHR that actually supports the ICD-10 codes. And even with assurances that ICD-10-compatible software is on the way, practices shouldn’t assume their vendor is on top of their game. In an early 2013 survey of top healthcare software vendor executives conducted by Emdeon, only 12% indicated that their technologies could support ICD-10 and 23% said they would have it available in the second half of the year. The rest of the respondents couldn’t say with any certainty when they would have ICD-10-compliant software available.
Testing, Testing, Testing
The industry learned with the conversion to HIPAA standard 5010 that testing with payer systems wasn’t as thorough as it should have been. But it is a vital activity to help providers avoid unexpected claim rejections, cash flow disruptions and implementation budget overruns. Leveraging updates provided by their hospital or practice management IS vendors, healthcare organizations should first test the interface and then the payer edits. Following these steps, they should be able resolve many issues during the testing process that would have become major problems later on.
The bottom line with the ICD-10 conversion is that if they haven’t already done so, healthcare organizations must begin preparing their staff the increased level of documentation that will be required to properly code a claim. Leveraging analytics in their EHR and practice management systems, healthcare organizations can gain a better understanding of how ICD-10 will affect reimbursements, allowing them to make the proper adjustments well before the changeover date.