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ICD-10-CM/PCS News Archives

ICD-10 could become a case study in large-scale preparation

January 14, 2016:

Magnus Leblanc, Senior Consultant, Optum360

After two months of working full-time with ICD-10-CM/PCS, what do we know about the success of providers’ transition efforts? In general, it’s too early to tell. It will likely be 90-to-120 days from implementation before we have solid revenue cycle data to determine the financial impact of ICD-10.

But in the meantime, organizations can assess how well they prepared for the transition and what they need to do going forward to ensure success.

In that spirit, we surveyed Optum360 clients to find out how they fared in terms of productivity, accuracy, documentation quality and other performance metrics. The findings indicate that, at least among the small population of health care providers we surveyed, that organizations were well prepared.

For this survey, we were particularly interested in understanding whether the use of computer-assisted coding has improved the success of the transition. Overall, those who fully implemented a computer-assisted coding (CAC) solution seem to be doing better than those who did not.

While industry estimates for productivity forecasted an initial decrease between 25 and 50 percent, the majority of our clients with CAC installed experienced steady productivity levels. Also of interest, a majority of our clients without CAC experienced a productivity drop of about 20 percent. From our initial review of the data and our understanding of our clients, it seems like the clients without CAC who did not see a significant drop can attribute their success to dual coding.

On the documentation side, we anticipated that we would see a jump in the number of physician queries related to coding. However, the overall number of queries that our clients are reporting remained flat. Other numbers reported, including discharged not final billed and case mix index, were also flat. (Because CMI doesn’t necessarily change on a dime, this number will need more study.)

What can these results tell us? While we can’t draw hard conclusions—this was a non-scientific survey with a non-random, self-reporting population—we can say with confidence that the results show preparedness as key to the successful transition.

Most of the ICD-10 headlines since October 1 for the Centers for Medicare and Medicaid Services (CMS) have emphasized the mildness of the initial reaction about the new code set. For example, ICD-10 earthquake barely caused a shake, ICD-10 day one saw small glitches, and Hospitals tout success on day 1 of ICD-10 transition, etc. The generally mild reaction after more than six years of hand-wringing shouldn’t be dismissed. This isn’t a case of much ado about nothing. This is a case study for being prepared.

Some observers compared the ICD-10 challenge to the Y2K challenge. It’s easy to see why. Both had significant IT implications, came with dire predictions and threatened to roar like a lion. But it seemed after the fact that both brayed like a lamb. However, the hype around ICD-10 was real.

Those for whom ICD-10 shaped up to be a “non-event” likely spent three-to-four years of effort getting ready. They trained and prepared professionals from multiple departments not only in what they needed to know about the transition, but also to help these departments know how to work together. They upgraded IT systems and tested with vendors, clearinghouses, payers and various other business vendors. Without all this preparation, ICD-10 would not have been a non-event; it would have been a “can we keep our doors open?” event.

While the implementation delay from 2014 to 2015 was disheartening for many in the industry, there is no doubt that the additional year of preparation helped. The fallout from ICD-10 would have been large and loud in 2014. But providers made good use of the extra time. They got their physicians and their coders better educated. They focused on EMR optimization and efficiencies, expanding CAC implementations, and enhancing clinical documentation and physician query templates.

While much of the hard work is behind us, there is still work to be done. Providers need to measure and manage around reimbursement analytics that will indicate revenue challenges ahead:

  • Days in account receivables (A/R): Review A/R days outstanding by dividing the last 12 months’ revenues by the net collectible accounts receivable outstanding at a point in time multiplied by 365 days
  • Discharged not final billed: Attend to held/suspended accounts, accounts awaiting clinical documentation and accounts awaiting query response from provider
  • Denial experience: Denial rates can be measured by first-pass resolve rate, clean claim rate, payer rule errors, utilization review denials, medical necessity denials, held or pended claims, etc.
  • Actual payments verses expected payments: Assess this metric by examining historic reimbursement data and trends, creating payer scorecards, analyzing payer cost neutrality and determining financial variation
  • Clinical documentation improvement program key performance indicators: KPIs include CMI, severity of illness, risk of mortality, complications and co-morbidities capture rates, chart review rate, query rate, physician response rate, and physician agreement rate

The industry will learn more about the effects of ICD-10 in the coming months. But everyone involved in ICD-10 preparation should take pride in the fact that the code set conversion was seen as anti-climactic.

This article is being repurposed from an original article published by ICD10monitor.com. ICD10monitor is the industry leader for news and information on ICD10.


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