ICD-10 implementation, mandated for every healthcare organization covered by HIPAA regulation, is set to begin Oct. 1. ICD-10, short for International Classification of Diseases, Revision 10, is a big change in coding processes for physicians and other providers, as it will be what’s used to code all diagnoses, symptoms and procedures recorded in hospitals and physician practices.
The update means that all billing systems, insurers and other payers, medical offices, clinics, hospitals and others in the ecosystem will need to speak both ICD-9 (the current revision) and ICD-10 in their software systems—and be able to use both interchangeably and together until ICD-9 is phased out altogether. Without proper preparation, the transition could have all of the hallmarks of a data management nightmare.
A national survey of healthcare organizations by Porter Research focused on ICD-10 preparation and found that while preparedness is improving, it still varies widely. Compared to a similar Q1 2015 survey, more organizations are on track for implementation (43 percent vs. 21 percent).
And, the overwhelming majority of respondents (85 percent) are optimistic they will be prepared for ICD-10 even though 57 percent of respondents aren’t necessarily on track yet. However, the firm said that organizations should ward off complacency if they expect to have a good transition outcome.
“ICD-10 is both a broad and complex undertaking that impacts every area of healthcare organizations,” Porter warned in the report. “Healthcare organizations must move forward with preparation toward implementation. Mitigate any productivity and cash flow disruptions resulting from ICD-10 by improving revenue cycle process in advance of the transition. [And], organizations should begin end-to-end testing if they haven’t already, especially knowing their major concern is the impact of cash flow from ICD-10. One way to address this concern is to test beforehand.”
Respondents said that their greatest concern is ICD-10’s impact on revenue and cash flow, with 56 percent naming this as their top concern. The overwhelming majority (94 percent) of participants anticipates an increase in their denial rate, but only 30 percent have improved their denial management processes in preparation for that.
Actions to be proactive on this front include improving patient collections (34 percent) and patient price estimation (17 percent). But on the down side, 35 percent still have not adjusted their revenue cycle in preparation for ICD-10.
Unsurprisingly, respondents feel ICD-10’s biggest challenge will be the increased clinical documentation update/coding requirements. Thirty-one percent of participants cited this as their biggest challenge, followed by lack of payer preparedness resulting in disruption to payments (27 percent).
Despite these clinical documentation and payer challenges, respondents were optimistic in regards to productivity loss, with 46 percent estimating losses at less than 20 percent.
As for the impact on patients, 65 percent believe it will be neutral and nine percent feel it will be positive/very positive.
Porter suggests that healthcare organizations take the necessary steps to get ready for ICD-10 now, so that they can prepare to test the changes they make, as well as test with capable payers.
Organizations can also take steps to improve their revenue cycle impact now, like putting processes and technologies in place to help collect patient balances, and automating eligibility verification, patient collections and denial management
“Unfortunately, what happens with payers is largely out of your organization’s control,” Porter added. “However, that is not the case when it comes to patient payments. Ensure that you have a financial policy in place that allows you to collect from patients at or near the time of service. Consider implementing a technology solution that enables you to securely store patients’ credit/debit cards online and charge them in full or as part of an automated payment plan once patient responsibility is determined. Do not let your patients leave your office without a commitment to pay their portion of their healthcare bill.”
Edited by Rory J. Thompson