Six Months In: Preparation Eased Community Hospital Transition to ICD-10

By , VP Revenue Integrity April 26, 2016 Regulatory Requirements, Revenue Cycle

October 1, 2015, was a much-anticipated day for the U.S. healthcare system. It was the final compliance date for the shift from ICD-9 to ICD-10, a set of codes used to report diagnoses and inpatient procedures to identify health trends and track morbidity and mortality. The Centers for Medicare and Medicaid Services (CMS) characterized the change as “more than an update, a leap in how we define care.”

Physicians, hospitals and health insurance companies rely on these codes for diagnosing patients and billing for services. ICD-9 had been used since 1979 with periodic updates. ICD-10 would introduce 69,000 diagnosis codes from the previous 14,000. Originally set to take effect on October 1, 2014, the deadline for implementation was pushed to Oct. 1, 2015.

How It Fared

Despite some trepidation and anxiety, transition to ICD-10 went more smoothly than expected on both the provider and payor sides. Many billing elements remained fairly constant pre- and post-transition, including claims submissions, rejections and denial rates. Early reports suggest there have been no major disruptions in claim submissions and payment for providers, or a significant productivity drain. The delay in the implementation date allowed extra time for preparation, communication and training, decreasing the risk of major problems.

Readiness Makes All the Difference

To help hospitals get ready for the change, CHC’s support focused on communication, education and teamwork. Preparation and collaboration would be critical in making the move to the new system. Some of the steps to a less worrisome ICD-10 implementation included:

  • Formation of interdisciplinary hospital teams with representatives from various departments — not just medical records coders;
  • Monthly group calls for hospitals to share and discuss information and best practices;
  • Monthly meetings with individual hospitals to discuss project and action plans prior to the go-live date;
  • Collaborative testing with payors;
  • Development of contingency plans including safety net resources built into hospital budgets, such as contracting with coding companies to handle any potential work overload;
  • Online ICD-10 health education not only for coders but all affected parties;
  • Offering user-friendly apps for physicians;
  • Dual-coding exercises, focusing on hospitals’ highest-volume cases.

Looking ahead

Although data related to the actual impact of ICD-10 (positive or negative) is currently limited, one thing is clear: the critical role of documentation in the ICD-10 coding set. For instance, similar injuries on opposite limbs cannot be accounted for in ICD-9; with ICD-10, different injuries or varying severities of medical conditions can be coded. The bottom line is that enhancing documentation can lead to better, more efficient patient care. Documentation also gives valuable information to health care providers providing follow-up care to patients. Clinical document improvement (CDI) programs can be added to a hospital’s tool kit for staff education.

Finally, change is constant. A code freeze has been in effect to help manage the transition to ICD-10; however, regular updates to ICD-10 code sets will begin on Oct. 1, 2016, to account for new technologies and diseases. Implementation of an estimated 1,900 diagnosis and 3,600 new procedure codes are scheduled when the freeze lifts.

CHC takes a collaborative approach with clients to help them navigate change, such as ICD-10 implementation.

Learn More

Read about CHC Revenue Cycle Assessment offerings including coding and related support services.

By , VP Revenue Integrity April 26, 2016 Regulatory Requirements, Revenue Cycle

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