Once again, the nation is bracing for the anticipated widespread tremors of the ICD-10 conversion. Assuming the mandate is enforced on October 1, 2015, hospitals are — or had better be — building out their support strategies. Whatever your tactics, don’t underestimate the aftershock.
There’s no one-size-fits-all preparedness plan, but we do know one thing for certain: When ICD-10 hits, it’ll hit hard, even on the most prepared organizations. Getting through those first few weeks after the transition is going to be a challenge, but once you do, there will likely be some sort of period of calmness and seeming stability.
The problem is that with such a seismic shift in the foundation of our health care data, there are bound to be unanticipated reverberations. But here’s the thing: You won’t necessarily know in those first few days or weeks what your financial impact will be.
It’s not like that claim you send out on October 2 will be paid on October 3. You’re going to have to process a large volume of accounts through multiple payers before any real pattern can emerge, and by that point, you’d better have a plan in place for the aftermath.
It will be imperative to address changes on both the front end and on the back end.
Up front, you need to know and understand your baseline volumes for certain DRGs and codes. You can use business analytics tools to track and trend this so you can set your thresholds, and as claims go out the door, you can see if things fall into their expected places.
But watch out for the aftershock on the back end. Weeks and months later, as cash actually comes in, it may not be as much as you expected. How will you determine the root cause? You must be able to identify the issues affecting your cash recovery:
- Physician documentation lacked specificity, so codes/DRGs were less specific.
- Coders incorrectly or under-coded the account.
- The billing system didn’t properly process the claim.
- The payer incorrectly paid the claim (possibly due to backwards-mapping your I-10 claim to I-9).
Uncovering the root causes may be daunting and labor intensive, but it’s the only way to really figure out the issues and implement a proactive solution.
As compliance draws nearer, keep in mind that October 1, 2015, isn’t the only thing you need to prepare for. Be sure your organization doesn’t underestimate its need to plan for the aftershock when its ICD-10 coded claims are paid.
About the Author
Seth Jeremy Katz, MPH, RHIA is the Assistant Administrator, Information Management & Program Execution at Truman Medical Centers, and serves as chair of the Missouri Health Information Management Association (MoHIMA) ICD-10 education committee.