Dealing with the Aftermath of Hurricane ICD-10
By Michael Nissenbaum
It seems only fitting to compare the October 1, 2015 transition from ICD-9 to ICD-10 to a hurricane. Like a hurricane, we tracked the pending event well in advance. The news media were filled with stories speculating whether ICD-10 would hit as expected and what the potential impact might be.
Even as we braced for the worst, ICD-10 made landfall with a great deal of noise and fury. But according to a Porter Research and Navicure survey, 99 percent of the 360 organizations who responded said they were ready for it and survived the event itself, meaning they were able to begin using ICD-10 when the deadline hit.
Yet Hurricane ICD-10 also shares another characteristic with its physical world counterparts: the aftermath may have a longer-term effect than the event itself. So while all the cork-popping and victory laps back in October may have been well deserved, providers are realizing the forecast is not all sunshine and light tropical breezes just yet.
As you address the ICD-10 aftermath, be wary of some of the issues that may still crop up and prepare in advance to deal with them.
- Be prepared to set up specialized “per payer” rules. While it would be great if every payer organization was now fully converted to ICD-10, it’s still not the case. For example, some smaller workers compensation carriers still aren’t accepting ICD-10 codes, so providers must process their claims differently. Ideally providers can set up special rules in their electronic health records (EHR) and/or practice management (PM) systems to automate this conversion and avoid the need to make manual changes, or even worse, submit paper claims.
- Make sure your team is fully trained on the changes. While there is currently a grace period for unspecified ICD-10 codes, that leeway is scheduled to come to an end within the next year. Denials will then increase if you’re not prepared. The best approach is to act as if the grace period doesn’t exist. Ensure your team is trained to submit documentation that is specific enough to support the selected ICD-10 code in the event you’re ever audited. If your users are still struggling in this area, partnering with an expert third party for training may be a worthwhile investment.
- Become experts on your most common codes first. We have gone from 13,000 codes in ICD-9 to 69,000 in ICD-10. That’s a lot to learn, but your team doesn’t have to master all 69,000 at once. Identify your practice’s most commonly used codes and make sure you can get them right every time. Once those are in good order you can expand the training on a prioritized basis.
- Make the most commonly used codes available quickly through adaptive learning. Take advantage of technologies that “remember” the codes that are used most frequently and make them readily available without a lengthy search process. This will enhance user productivity and minimize user frustration.
- Consider technologies that take advantage of natural language search. Another way to improve productivity under ICD-10 is help providers find specific codes faster. Natural language search allows a user to type in “chest pain,” for example, and be presented with answers that match chest pain specifically, as well as related terms such as angina and other heart-related diagnoses. This significantly reduces the time it takes for providers to search for the right level of specificity, especially when first learning new codes.
- Take advantage of automated correlation between ICD-9 and ICD-10. Providers that are still learning ICD-10 may benefit from technologies that allow them to type in a familiar ICD-9 code and have the system narrow the choices to a closely related ICD-10 subset. While there will not be many one-to-one relationship between codes, trimming the options can be a huge time-saver.
- Speed the selection process with filters. Technologies that use filters to navigate the ICD-10 coding process can also enhance productivity. These solutions deliver a step-by-step approach to drill down to the correct category (e.g., diabetes or chest pain,) followed by more precise options (e.g., left or right.)
- Make sure your team understands the importance of these changes. It’s human nature to resist change and providers have had more than their share of changes thrust upon them in the last few years. But failure to comply with ICD-10 affects reimbursements for both the practice and the individual providers. Be as encouraging as possible and keep working to ease the transition.
While Hurricane ICD-10 may have passed through in October, there’s still work to be done. Many organizations are still suffering from productivity losses that could impact their financial success for a long time to come. If your organization is still not recovered from the ICD-10 aftermath, consider the implementation of time-saving technologies and partnerships with knowledgeable experts that can deliver the training and support you need.
Finally, it’s worthwhile to remember that the ICD-10 implementation date was pushed back twice, which is akin to giving providers 15 days warning for an impending storm versus a mere five days. Take note, all you rule-making bodies, and consider how a more sensible implementation pace contributed to the relative success of the ICD-10 transition. Something to keep in mind next time anyone considers cramming providers with a new round of arduous regulations in unreasonable timeframes.
Michael Nissenbaum is president and CEO of Aprima Medical Software of Carrollton, TX.