ICD-10-Produced Problems: How to Manage the Ongoing Impact

January 19, 2016 by Antonio Arias, MBA, CHBME

Topics: Revenue Cycle Management, Practice Management, Medical Billing Company

After all of the industry-wide infighting and regulatory postponements that marked the years leading up to the mandated shift – at long last – to exclusive use of the ICD-10 code set, the implementation phase has finally passed. And despite the extensive bickering and delays, the switch ultimately went by with less of a bang than a whimper.

How individual healthcare-sector stakeholders feel about ICD-10 depends, naturally, on their role and personal experience with the shift. But overall, results are fairly positive: 79 percent of responding organizations to a KPMG survey reported a successful ICD-10 transition since October 1, 2015.

But medical billing professionals may not be entirely out of the ICD-10 weeds just yet. (And we’re not talking about those in the 11 percent of organizations that told KPMG their transition was a “failure.”)

“Organizations are beginning to see dips in cash flow due to payers delaying the processing of ICD-10 claims while they ensure their ability to appropriately adjudicate these claims,” says Craig Greenberg, KPMG director. “Others are seeing an increase in claim denials over pre-ICD-10 levels.”

Others predict the impact on organizations’ revenue is yet to come, believing that the specificity in the data provided by the new code set will lead insurers to lower the prices they pay based on the severity of the diagnosis code.

Either way, hospitals and medical practices are wise to stay alert to potential ICD-10-produced problems. Here are our tips for staying on top of the new code set’s ongoing impact.

Bolster Denial Management: To notice any new denial trends stemming from the ICD-10 shift, you need to pay more focused attention to why your claims are denied. Categorize denials by reason (payer-related, diagnosis-related, coverage-related) and where each denial was processed. Note the percentage of denials associated with each reason, payer, or clearinghouse; find and address the root cause of every single denial before fixing and resubmitting; and raise a flag with the responsible party if you see troubling trends in your data.

Monitor Your Most Important Metrics: Compare your claim-related performance indicators – total days in accounts receivable, number of encounters billed, percentage of uncollected claims – from the present moment to those from before the shift to ICD-10. If you see any odd spikes, take immediate action to address the source of the problem, be it internal error or payer mistakes. Stay engaged by checking back in on your claim-centered KPIs every sixty days (or less).

Provide Continual Education: If you equipped your team with an appropriate amount of knowledge and information prior to the ICD-10 shift, you likely feel confident that they’re handling it with aplomb. But don’t let them (or you), rest on the laurels of that earlier education. Don’t just provide remedial education to the billers and coders you notice struggling with the change – invest in ongoing education to keep your entire team informed and prepared for any potential problems.

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