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Are we making progress with ICD-10 preparedness?

Are we making progress with ICD-10 preparedness?

Author Name Jennifer Bresnick   |   Date October 18, 2013

Is there a glimmer of hope on the ICD-10 horizon?  October’s preparedness survey conducted by Health Revenue Assurance Associates (HRAA) seems to indicate that providers are making some progress towards the October 1, 2014 transition date.  The results showed modest increases in the number of organizations beginning staff training, dual coding, and clinical documentation improvement.

One year away from the conversion, things are starting to get serious. While 60% of hospitals in April of 2013 had started ICD-10 CM training for their coding staff, an additional 18% have started to sit their coders down for education.  Sixty-four percent have started PCS training, compared to 45% in April, and 17% of hospitals have added dual coding to the agenda in response to the warnings about productivity losses anticipated during go-live.

“It is clear that ICD-10 is happening, and significantly more hospitals have begun programs since April” said Andrea Clark, Chairman and CEO of HRAA. “This is vital as coder productivity is expected to decrease by more than 70 percent with the transition. The better trained a hospital’s staff is the more of a chance they can beat these estimates.”

But the news isn’t all rosy.  The vast majority of hospitals have no idea if their payers are planning to map claims utilizing CMS reimbursement maps to group the claims to DRGs. Few hospitals are evaluating the potential DRG grouper shifts inherent in the ICD-10 revamp, which may have significant reimbursement impacts.

“We truly believe it’s going to be a problematic area if hospitals do not engage and understand how they are going to map and pay them under the DRG model,” Clark told EHRintelligence. “If they do not engage in that conversation and October 2nd, 3rd, 4th, or 5th of 2014 comes along, they can be surprised at the amount of denials they may receive along with suspension of claims and not have a strategy in place to correct those problems.”

“The survey data shows that while hospitals are focused on testing and preparing internally, they are not focused on mapping and the financial impact of the transition.  We are encouraging our clients not to make assumptions but to implement technology and analytics to do the financial modeling and denial strategies now, so that they won’t be playing a guessing game with their payers once the transition takes place.”

Quality assurance of claims coded in ICD-10 is also lacking among hospitals.  Only 36% plan to assess claims from a CDI standpoint, and 32% will rely on reports from computer assisted coding software.  Few hospitals plan to let external coding or CDI vendors help them with their accuracy and completeness, which may be problematic in light of a recent pilot test that showed just how difficult it was to produce accurate ICD-10 claims.

“The good news is that hospitals have jumpstarted their training and documentation improvement. The not-so-good news is that they are not putting enough resources against understanding how their payers will operate once the ICD-10 transition takes place,” Clark concluded.  “This change is a massive shift in the healthcare system and it is vital that hospitals are compliant and ready on October 1, 2014.”

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