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Moving Forward with ICD-10

Looking back, the coding conversion has played out significantly better than even the optimists imagined.

Some have suggested that much like Y2K in the late 1990s, the transition to ICD-10 was analogous in both anxiety buildup and non-event outcome. Those who now celebrate the "non-event" know firsthand that the success realized was due to years of preparation and hard work by all involved. Although some of us remained cautiously optimistic all along, it still was unknown whether the nation's entire healthcare industry and its stakeholders would be able to successfully transition together on October 1, 2015.

Looking back, the transition has played out significantly better than even the optimists imagined. After all is said and done, it was a major revision update to a known and established code set.

As we put this transition behind us and prepare for the next milestone - the end of the "partial code freeze" on October 1, 2016 - healthcare providers should turn to key strategies and best practices to ensure sustainable momentum for optimizing reimbursement and clinical documentation with ICD-10.

Celebrating a Successful Transition

With early forecasts estimating that coding productivity would slow by 20-50%1-3 and claim rejections and denials would increase creating revenue cycle disruptions,4 it is obvious healthcare providers heeded the "lessons learned" from other countries' transitions. Providers took the challenges seriously and focused resources accordingly to ensure their preparedness.

SEE ALSO: Proposed PSI Changes for 2017

According to a March 2016 Centers for Medicare and Medicaid Services (CMS) survey conducted by the Workgroup for Electronic Data Interchange (WEDI), the national ICD-10 conversion has had minimal impact on productivity or business operations, as was originally feared. Likewise, most providers experienced only nominal fluctuations in overall denial rates, with the most common denial reasons remaining much the same, such as missing information or submission/billing errors, non-covered charges, denials based on PQRS or EHR incentive programs, plan benefit or contractual agreement restrictions, and patient eligibility.

Specific to claim denials with mention of diagnosis in the remarks, Change Healthcare analysis revealed increases in denials were realized post-transition as expected, but accounted for a less than 1% increase in overall denials.

Ensuring that not just providers but software vendors, clearinghouses and payers were technically and operationally ready on October 1, 2015 was no small feat.

Industry-wide success can be attributed to years of early planning, resource acquisitions, training and testing. Stakeholders worked together to coordinate, collaborate and effectively communicate with each other - all of which promoted out-of-the-gate interoperability and readiness. When issues did arise, the industry was keenly focused and worked in unison to quickly identify and resolve them.

Sustaining Momentum and Optimizing ICD-10

Moving forward, healthcare providers and other industry stakeholders will begin seeing the effects and benefits of enhanced code specificity and clinical documentation improvement (CDI). For instance, the higher level of specificity provided by ICD-10 will assist in driving policy and payment refinements - including the shift from fee-for-service to fee-for-value payment models that CMS and some commercial insurers are adopting.

When the partial code freeze ends later this year, the industry will need to focus on stabilizing the new code set and resuming "business as usual." This doesn't mean providers should dial down efforts. On the contrary, they should maintain momentum to sustain productivity while continuing to concentrate on CDI and quality outcomes.

Using tools such as CMS's "Next Steps Toolkit" and "ICD-10 KPIs at a Glance," providers can assess their ICD-10 progress by establishing a baseline and tracking key performance indicators (KPIs) over time. KPIs such as days to final payment, reimbursement rate, claims denial rate, requests for additional information and coder productivity can be used to identify and then address opportunities for improvement.

Healthcare providers can leverage value-add revenue performance solutions and services that track and measure key KPIs to optimize productivity, patient and billing workflows, coding accuracy and revenues.

Looking Ahead

Cyclical updates to healthcare code sets are established industry practice and typically occur with minimal fanfare or disruption. Future updates to the ICD-10-CM and ICD-10-PCS code sets should be no different. Many of the updates scheduled to occur October 2016 are actually highly anticipated and welcomed due to the four-year partial code freeze. Specifically, the preparations made for ICD-10 will help the healthcare industry as a whole evolve, improve and adapt to ever-changing dynamics and complexities.

Yes, alongside other developed nations, we've crossed the ICD-10 finish line. We should be proud of that. The vast majority within our healthcare industry were ready despite the dire forewarnings and endured anxiety. Now, it's time to look ahead.

Mike Denison is Senior Director, Office of Compliance and Ethics for Change Healthcare.

References

1. Stanfill MH, Hsieh KL, Beal K, Fenton SH. Preparing for ICD-10-CM/PCS implementation: Impact on productivity and quality. Perspectives in Health Information
Management. Available at http://perspectives.ahima.org/preparing-for-icd-10-cmpcs-implementation-impact-on-productivity-and-quality/#.V0eypPkrLIV, Accessed May 26, 2016.
2. Jordan JA. ICD-10 productivity. HIMSS News. 16 Jul 2013. Available at http://www.himss.org/News/NewsDetail.aspx?ItemNumber=21533, Accessed May 26, 2016.
3. Johnson K. Implementation of ICD-10: Experiences and lessons learned from a Canadian hospital. AHIMA Library. Summer 2014. Available at http://library.ahima.org/doc?oid=60124#.V0eyr_krLIV, Accessed May 26, 2016.
4. Natale C. Managing denials after ICD-10: Healthcare providers will need a denials manager who can track denials and communicate with healthcare payers. Healthcare Finance News. 13 Nov 2014. Available at http://www.healthcarefinancenews.com/blog/managing-denials-after-icd-10, Accessed May 26, 2016.

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