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Checking in With ICD-10 (Part 1)-Katy Zillmer

The updated ICD-10 medical diagnostic coding system, which took effect last year, has allowed healthcare providers to more accurately describe a patient’s care for insurance reimbursement, but mistakes can cause claim denials and delays—ultimately impacting their revenue cycle process.

ICD-10 is a replacement for ICD-9, which is used to document medical diagnoses and inpatient procedures.  The switch to ICD-10 added more than 69,000 codes for diagnoses and more than 71,000 for procedures, according to the Centers for Disease Control and Prevention. All entities covered by the Health Insurance Portability and Accountability Act were required to implement the new system by Oct. 1, 2015.

“At its core, ICD-10 is not a bad thing,” said David Yohe, vice president of marketing for Billing Tree, which works on payment processing for healthcare provider clients. “It’s about having a more granular way to reflect what the physician or the care given ended up being for.”  Yohe said his provider clients have not reported a noticeable difference in the dollars they collect; just a delay in their revenue cycle processes.

“It’s just pushing their revenue cycle out longer,” he said. “It’s adding 20 to 40 days to the receivables cycle as a result of the back-and-forth and the coding.  They are not sure that it’s going to have a big effect in the long term as far as the amounts due.”  Looking back at the time leading up to implementation of ICD-10, which included multiple testing processes and delays of the effective date by the Centers for Medicare and Medicaid Services, Yohe said providers were most concerned about getting their systems ready and whether they would experience a large number of insurance reimbursement claim denials.

In May, the Workgroup for Electronic Data Interchange released post-ICD-10 implementation survey results showing the delays by CMS “improved the ability to perform testing and resulted in a smoother transition.” The survey, conducted in March, is one of several completed by WEDI to track the status of the implementation process in the healthcare industry. WEDI shared the findings with the U.S. Department of Health and Human Services.

“We wanted this post-implementation survey to be a closing chapter of assessment on why the transition went so well overall and also to leverage specific lessons learned for future large implementations,” said Jean Narcisi, chair of WEDI in a news release.  WEDI received a low response rate to the March survey compared to others, indicating ICD-10 project personnel are reassigned to other work “and likely a lack of interest in further ICD-10-related activities that are not operational in nature.”

Common themes in the survey responses included the value of starting the testing process early, communicating with partners and conducting extensive testing, according to the WEDI news release.  Overall, the transition on Oct. 1, 2015 was considered “non-eventful” by some in the industry, according to WEDI and survey participants said CMS’ ICD-10 website, WEDI’s website and coding materials from industry organizations were all helpful tools.

There was a slight decrease in productivity for providers, especially in the areas of coding and clinical documentation, but the impact for vendors and health plans was primarily neutral, according to the survey.  Overall, WEDI concludes from the survey that the collaboration in the industry was a “major factor in the success of the ICD-10 transition.”

Part II “A Look Back at Preparing for ICD-10” will appear in our next issue.

Last modified onWednesday, 06 July 2016 17:52
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