ICD-10 has been the talk of the town in our nation’s capitol this year. The House Energy and Commerce’s Health Subcommittee took up the topic just weeks into the first session of the 114th Congress.
The new coding system, which is set replace the 30-year old ICD-9 as the system to report medical diagnoses and inpatient procedures, has been implemented in almost 25 of countries since being finalized in 1992, but has been repeatedly delayed in the U.S. First in 2009, when the date was moved to from 2011 to 2013, then in 2012 it was moved to 2014, and then in 2014 to this year. All those delays can make a healthcare organization feel like they’re living inside a Talking Heads song.
But, while certain entities are praying for another delay, or an outright knife in the back of the code set (which, I believe is code X99.1XXA in ICD-10), if congressional testimony is any indication, this could be the year.
Out of the seven witnesses who testified before Congress, only one opposed the transition. Dr. William Jefferson Terry, an urologist from Alabama, said, “The vast majority of America’s physicians in private practice are not prepared.” Noting Terry’s isolated stance, the ranking minority member of the subcommittee, Rep. Gene Green (D-Texas), commented, “You probably feel like you’re at the Alamo.”
And perhaps he is, but will Terry’s stance prompt any more to join him? And, will anyone remember his comments in October of this year? It appears unlikely.
The United States Government Accountability Office (GAO) released a report in January saying that the Centers for Medicare & Medicaid Services (CMS) are ready and CMS itself announced this week the completion of the first round of 15,000 test claims, putting them on course for successful implementation.
Heck, CMS is even posting cartoons on YouTube about how to deal with the transition. So that means it’s gonna happen, right?
Physician groups and hospitals have already spent a considerable amount of time and money preparing for this transition – some studies show costs range in the millions of dollars for large healthcare facilities. However, recent estimates point to much lower costs than expected for small physician practices.
But let’s get something straight. October 1st is not the end of the road. It’s only the beginning.
For all of the preparation, some amount of chaos is likely to ensue when the transition occurs. Because the new system increases the number of codes used from approximately 18,000 to 140,000, CMS predicts that claim error rates will be more than double. So expect coder productivity to significantly drop during the first months of ICD-10 use.
Also, under ICD-10 rules, providers will be incentivized to educate patients on the details of their insurance policies, but many providers are not prepared for that reality. Coding errors may induce providers to shift payment responsibility to patients if insurance doesn’t cover the diagnosis or rejects a claim.
So it’s no wonder that ICD-10 is the number one IT concern among healthcare executives and it’s sure to be a hot topic at April’s annual HIMSS conference in Chicago, where nearly 40,000 health IT professionals will come together.
So what’s a healthcare organization to do?
All of these concerns – additional costs, loss of productivity, and shifting patient responsibility – can be alleviated with a proper plan in place and smart use of the time left before the deadline.
In fact, Pam Jodock, senior director of health business solutions for HIMSS North America says, “There is an expectation that the industry will experience a temporary increase in pended or rejected claims, but given the additional time we’ve had for testing and the positive results we’re seeing from that testing, this may not be as big an issue as originally thought.”
Minimizing Productivity Loss
HIMSS has estimated that coder productivity will dip 25-30%for diagnosis coding and up to 50% for new inpatient procedure coding.
To minimize the loss of productivity, make sure your coding department is fully staffed, certified, and trained before the go-live date. Coding staff should have at least three months of training and those who are not currently certified take advantage of this opportunity to achieve certification. Outsourcing coding during the transition can provide coverage for your staff until you’ve achieved full implementation.
Additionally, your organization should use this time to ensure their practice management and electronic health records (EHR) systems are ICD-10 compatible. Identifying the most common billing ICD-9 codes used by your organization and their ICD-10 equivalents can also give you a head start.
Covering Additional Costs
Many practices and hospitals are estimating they will need three to six months of cash reserves on hand while the new system works itself out. In fact, 59% of physician practices are most concerned about ICD-10 cash flow impact and revenue, according to a recent Navicure ICD-10 readiness survey. Additional operating dollars can help your organization cover any revenue shortfalls that result from pending or rejected claims.
Also, take time to start a dialogue with your largest commercial payers. CMS suggests sending them copy of the Payer Assessment and this may be a great place to start the conversation. Ask for any policy and/or reimbursement changes your payers are making and ask for a copy of any crosswalk from ICD-9 they may be using. That should allow your organization to understand how reimbursements might change.
Cracking the Patient Responsibility Code
Since the patient is now the #3 payer behind Medicare and Medicaid, providers should thinking about redefining their revenue cycle. The revenue cycle used to begin at the time of service, but in today’s consumer-focused environment your revenue cycle should begin before your patient ever walks in the door. Getting proactive can mitigate many of the concerns associated with the ICD-10 implementation.
Connect with patients before they visit. This can not only prevent delays but also reduce denials. In the process of providing your patient with information they want – setting appointments and providing reminders – your revenue cycle staff can verify insurance and, in some cases uncover secondary insurance.
At the time of service, show your patients how easy paying their bills can be. Start by telling them what they can expect in their bill and inform them of their payment options. Offering payment plans and incentives for payment upfront can greatly increase reimbursement. Point of Service (POS) payment portals and kiosks can make it quick and easy for returning patients to pay their balances at the time of service.
After their visit, continue to help your patients understand their bills. A post-visit call, thanking the patient for their business, can also be used to conduct a patient satisfaction survey. Patient satisfaction surveys demonstrate that your organization is interested in quality and in doing things better, help you identify ways of improving, and increase return business.
The Hospital Value-Based Purchasing (VBP) portion of the Affordable Care Act returns higher Medicare reimbursements based on patient experience scores. The payment process is integral to the patient experience. Patients who don’t understand their bills, what they owe, and why they owe it tend to give lower scores on patient satisfaction surveys. In 2013, more hospitals were penalized than bonused, leaving millions on the table.
Is your organization ready for the ICD-10 transition? What are you doing to be proactive and curb the chaos?
Are you attending HIMSS15 in Chicago this year? Stop by our booth #4851 to learn how MedData can boost your bottom line and create a better experience for your patients.