ICD-10 Post Implementation:
News from the Front Lines
Agenda
• ICD-10 Post Implementation
• Coder Productivity
• Coding Quality
• Physician Engagement
• Managing Denials
The Good News
• What Really Happened?
• Not much! Non-eventful, being called the Y2K of healthcare
• Primarily due to the collaboration and preparation by providers, hospitals, health plans and carriers
• CMS flexibility rule to not deny claims based solely on specificity of diagnosis code as long as they are from the appropriate family of ICD-10 codes
• Coder Productivity initially dipped in the first month, but returned to normal production levels
The Bad News
• What Really Happened?
• Not Much!
• Current data analysis is not showing that Physicians have changed their
documentation style or patterns; EHR and coding tools designed to keep code selection neutral
• May not be seeing the true benefit of new codes quite yet
• Some specialties (Radiology) affected in some jurisdictions due to NCD and LCD errors
• Claims denials may be increasing
WEDI - ICD-10 Post Implementation Survey
• Survey will focus on transition process itself. Questions
include:
- What worked
- What might have gone better; Underlying factors – what could have been done differently
- What resources were used to find out about ICD-10 and which were the most helpful
- Impact to operations and productivity; Business units impacted either negatively or positively
Coder Productivity
• Few early studies showed a temporary drop of 30-50% in
productivity in the first 3 months of the implementation
• It is predicted that a 20% permanent reduction in
productivity will remain
Coder Productivity
• Tools needed to assist with productivity loss
• Review the official ICD-10 coding guidelines
• Review AHA’s Coding Clinic for ICD-10-CM and ICD-10-PCS
• Review EHR content and format to ensure coders can easily access
information for all specialties; documents, scanned images and forms. Improve the design, color, text size and organization if necessary;
• Analyze workflow – automate queries, coder task queues, physician inquiry logging, etc.
Coder Quality
• Focus has been on coder productivity, but most coders
adapting and production has leveled out
• Turn focus to quality of the coding
• Evaluate your Coder quality by conducting coding audits
• Monitor accuracy rates
Physician Engagement
• CMS reporting that no additional increase of provider calls or
complaints
• One year grace period aiding in transition BUT…
• Not all payers following Medicare’s grace period lead
• Managed care contracts requiring risk adjustment coding
require specificity
Engaging Physicians Into Specificity
• ICD-10 specificity is the backbone of this implementation but we are
still seeing many specific codes not being used
• Citing Dr. Joseph Nichols white paper study “the opportunity of ICD-10
is to clarify the nature of the condition and identify potential
differences in risk, severity and complexity for different patients with
similar types of conditions… Opportunity does not however imply
Documentation Concerns
• Concerns in documentation specificity which include the
following:
• Laterality • Location • Ambiguity • Disease Type
• Disease Acuity (Chronic, Acute) • Disease Stage for CKD
• Combination Codes
• Etiology & Manifestations (Diabetes, Anemia, Ulcers) • Dependence (Alcohol & Nicotine)
Finding a Way to Help Physicians
• Educate physicians in the use of combination codes
• Review terminology that may be inconsistent with their common use
or within ICD-10
• Provide access to meaningful analysis of physicians claim coding
patterns and how their patterns compare to expected benchmark.
• A thorough analysis of the work flow of clinical data capture and
system input to identify process improvement opportunities.
• Physician incentives should be created to reward accurate, complete
and specific definition of the patient health conditions they are
Denials Creeping Up
• Claim denials are increasing from 4% to 7%; Traditionally has
been around 2%
• Not all payers have implemented all I-10 edits yet; more
coming
• Organizations may not be monitoring denials as closely; or
claims being fixed and not informing anyone
• Getting paid but not reviewing the EOBs to see if payers have
changed something – 1 in 5 claims being denied or being
Performing a Coding Denial Assessment
• Help physicians understand that documentation and the
coding process will have a direct financial impact on them
• Review EOBs and Remittance Advice
• Medical Necessity denials increasing; payment amounts may
not be accurate
Revenue Cycle Assessment
• Establish Key Performance Indicators
• Start at the beginning of your Revenue Cycle
• Monitor number of days from time of service to claim generation • Days of claim submission to payment
• Assess claim acceptance & rejection rates during front end edits
• Claim denial rates which is a percentage of claims accepted into the payer adjudication system which are typically denied
What’s Next
• Prepare for ICD-10 code changes
• 3,651 new procedure codes (ICD-10-PCS) and 487 code revisions and 1,928 new diagnosis codes (ICD-10-CM)
• Continued QA and Productivity monitoring • Continued review of physician workflows • Focus on CDI efforts
• Establish KPIs
• Educate providers and coders
