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Checking in With ICD-10 (Part II-A Look Back at Preparing for ICD-10)

The WEDI survey also shows there was value in testing ICD-10 claims during the implementation process, but the delays in the deadline had both positive and negative effects. “When additional time was provided, some organizations did not take advantage of this time. The extended implementation period also added costs for many organizations.”

In advance of the implementation date, BillingTree recommended its healthcare provider clients focus on preparing their infrastructure and technology systems for ICD-10 while communicating with patients and ensuring they had current contact information for payments they could use as permitted under the Telephone Consumer Protection Act. That way when a claim is processed, a provider can easily follow up with a patient about any balance due and resolve the account for both parties.

According to WEDI, a majority of healthcare providers responding to the survey indicated costs of ICD-10 were in line with their expectations or higher, but many also said the expenses were less than expected.  “The majority of respondents indicated that they did not expect to realize any [return on investment] with ICD-10,” according to the news release.

“The interesting part about ICD-10 was that it’s kind of like Y2K,” said Lyman Sornberger, chief healthcare strategy officer for Capio Partners LLC, during a presentation at ACA International’s Spring Forum and Expo. “Everybody panicked [and] it got delayed.”  Once some time passed, Sornberger said denials were inconsistent, reflecting increases from 3 percent to as high as 30 percent, mostly related to smaller hospitals being unprepared for the transition.

Now that ICD-10 has been in effect for several months, CMS is beginning to audit healthcare providers’ charts to test their use of ICD-10.  According to the CMS ICD-10 assessment and maintenance toolkit, providers should select high-risk cases to audit as well as cases representing a shift from the use of ICD-9 to ICD-10 diagnostic codes to identify any patterns of incorrect coding.

Sornberger said he knew of one healthcare provider that received a request from CMS for 1,000 charts, but there is no limit on how many they can request.  There are still some questions regarding if patients will notice any changes from ICD-10 or if the additional diagnostic codes will ultimately change the billing process.

Yohe said that if any delay in claims occurs under ICD-10, patients might be frustrated if they get a bill many months after they received care when they thought it had already been processed under their insurance.  To help smooth out any bumps, Yohe said healthcare providers should designate staff to work with patients on payments or determine a way they can easily pay over the phone or online.

“We saw an uptick in getting a phone system established specifically for payments,” Yohe said. He also recommended providers make sure they accept payments from medical savings accounts and flexible spending accounts.

“At the end of the day, the patient won’t get their bill until their insurance claim is settled and the patient balance is settled,” Yohe said. “That means passing the claim back and forth a few times between the administrative office and the healthcare provider before they get it right to establish patient responsibility.

As a provider, you’re at the mercy of two different parties getting paid.” Now that an initial set of ICD-10 codes—which bring consistency between the U.S. healthcare system and systems in other industrialized countries—are in place, more could be added in October, according to the website icd10monitor.com. 

There will be more than 3,600 new procedure codes and nearly 2,000 pending diagnosis codes. Yohe said that in the healthcare world, discussion is already starting about when we will see ICD-11. According to icd10monitor.com, however, ICD-11 is not estimated to be ready in the U.S. until 2023.

For now, healthcare providers should continue to communicate with patients and insurance companies and test their key performance indicators. According to CMS, tracking performance indicators can help providers address problems with productivity, reimbursement and claims submissions.  The WEDI survey results show the impact to productivity experienced by vendors and health plans was mostly neutral, but providers experienced a slight decrease in productivity.  

“Once you have established baselines for your KPIs, compare data pre-and post-October 1, 2015, to put your current KPIs in context,” according to CMS. “Tracking KPIs can help you detect problems and identify opportunities for improvement.”

Last modified onWednesday, 20 July 2016 00:00
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