December 3, 2015 Owen Carey

Why the Healthcare World Didn’t End with ICD-10’s Switchover

ICD-10 implementation – much more than a mere annual coding or technology advancement – has formally reached its one-month anniversary with ICD-10 optimism apparently going strong as the healthcare industry enters into November.

Dave McCann, Managing Director at Berkeley Research Group’s Clinical Economics practice, chatted recently with to offer valuable insight on the greater implications of over 100,000 new ICD-10 medical codes and why the healthcare world thankfully did not end as some anticipated with the new switchover.

Extreme worst-case scenarios proved problematic but rare

According to McCann, ICD-10 has unfolded favorably since its October 1, 2015 implementation date. Frustration levels were at their highest within the first few days of October, he says. By the end of mid-October, there was noticeably greater comfort regarding high-volume coding efforts.

“It really boiled down to how well the facilities and individual physician practices prepared for the transition,” McCann says.

“There were a few glitches in some of the Electronic Medical Records where tools are in place to find codes for physicians. There were maybe some things that weren’t put in with enough time that facilities fought through and fixed,” he states.

McCann says the most sizable problem involved working with unprepared individual physician practices hoping another ICD-10 delay was in the cards.

“There was a mad scramble towards the end to get resources and computer systems updated,” McCann states. Some physician practices still using old ICD-9 codes in association with outpatient diagnostic tests and patient referrals, which became especially problematic, says McCann, when the hospital setting was subsequently unable to provide tests and medical necessities without current codes.

“We’ve had places where on October 1st, patients were coming in for outpatient testing and the coders and billers didn’t even have an ICD-10 codebook. They weren’t prepared on any level for this,” says McCann.

Although such was not a common occurrence, he explains, such was a harsh reality for some. “They couldn’t justify the exam because they didn’t have a code to go with that. That was the extreme worse-case scenario,” he explains.

“Most places did a nice job preparing their coders for the transition. They went to ICD-10 classes to avoid major backlogs in coding. They lined up vendors or coding support or increased staff. They were pretty well prepared to handle it,” explains McCann.

Physicians are now collaborating beyond their own four walls

Physicians are requesting more detailed documentation regarding ICD-10’s greater ICD-10 levels, McCann maintains. Enhanced communication efforts have proven beneficial, McCann says, as ICD-10 encourages physicians to expand their contact list and operate well beyond the usual four walls of their practice.

Communication as ICD-10 unfolds, says McCann, is needed between hospitals and individual physician practices to ensure either a specific diagnosis or accurate ICD-10 codes is being provided.

“The key is communication where the hospitals – whether it’s the hospital staff or if they have a documentation improvement program – are sharing the findings with the physicians so in the future they can document it accurately,” McCann says.

McCann says ICD-10 coding efforts have been notably strong within the inpatient realm. “On the inpatient side, hospitals have been able to get billing done in a fairly timely manner with minimal backlogs.”

Maintaining ICD-10 accuracy is detrimentally time-consuming

As reported, 86 percent of physicians confirm ICD-10 diverts needed focus away from patient care. Echoing this concept, McCann says physicians are indeed becoming increasingly frustrated with an apparent loss of productivity caused by merely trying to keep their revenue cycle management running up to speed.

It simply takes ample time to execute ICD-10 endeavors with accuracy, he says. “Physicians were used to documentation in the ICD-10 world. If they were in a setting where they needed to identify the code for their own billing purposes, they had a list of common diagnoses they used over and over again,” explains McCann.

“The ICD-10 transition is now putting a greater burden on their time to go through and provide that detailed documentation and find correct codes,” he adds.

Reimbursement remains generally unaffected since the switchover

Reimbursement has not changed much since ICD-10, says McCann. Although healthcare payers experienced some issues regarding upfront denials, such were smoothly rectified, he states. “They’ve been pretty lenient. They’re accepting more unspecified codes than we thought that they might. That could have been a big problem,” he explains.

McCann says with the passing of time will come increased familiarity with ICD-10 coding, especially as physicians repeatedly see the same patients for the same medical concerns. Physicians will likely recreate a common diagnosis list to work off of once they have a clearer grasp on what the most common codes utilized are, he says.

“When facilities are billing, if there are denials or problems, they need to share that back with the physicians. It’s a two-way street. Physicians have to be open and share their burdens that they may have with the tools – either with the electronic medical records, finding codes, that type of thing,” he says.

No one can assume they have ICD-10 down just yet

Denial management fear, says McCann, will be hanging over everyone’s head as more ICD-10 data pours in come mid-November.

“No one is in a position yet where they can just assume they have this down and can just go about their business. They have to keep analyzing the data and finding out what’s causing the denials and then provide education,” says McCann.

Physicians who are essentially working in isolation when it comes to documentation are both inquisitive and hungry for positive ICD-10 feedback to help reinforce their behavior and keep them on the right path, says McCann. A lack of specificity with physician’s documentation is fixable with education, he adds.

“If they don’t hear anything back as far as if there have been problems with documentation or codes, they have to cross their fingers and hope that they’ve been doing things correctly,” says McCann. “Most physicians are trying to do their best and want to do it accurately. They understand the ramifications their documentation has.”

“Everyone saw the world hasn’t ended because we’re at ICD-10,” says McCann. “As long as they continue to monitor the documentation, the coding, and the billing, and then nip any problems in the bud, they’re going to be just fine. ICD-10 has gone better than the worst-case scenarios people expected. They survived it. Now, they just have to keep moving, tracking, and improving.”

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