CHICAGO -- Attendees of the AHIMA 2012 Convention and Exhibit might have gotten a one-year reprieve on ICD-10 implementation from the Centers for Medicare & Medicaid Services, but that doesn't mean it's time to slack off. A cross-section of folks on the trade show floor indicated that C-suite hospital leaders still don't grasp the full implications of the new billing and coding language.
Health information managers are in the position to demonstrate to those leaders, such as the finance department, that now is the time to devote the resources for a smoother transition, said Angela Carmichael, assistant vice president of coding and auditing for Pyramid Healthcare Solutions.
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"They don't understand the risks of not being prepared, the financial risks," Carmichael said. She added HIM managers should use their software resources to assess opportunities for improving reimbursements through more accurate coding of health care procedures and training staff to take advantage of them. Then take that assessment to the hospital business leaders. "If you just sit back and let ICD-10 happen without preparing for it, you will not be strategic. But the payers will, and that means we're playing their game instead of taking the lead and letting them play our game."
Specifically, she suggested the ICD-10 delay will give HIM managers and IT staff more time to get together and run the last two years' worth of coding data from ICD-9, translate it to ICD-10, and identify where it would have increased reimbursement. Conversely, they can identify root causes of where reimbursement would have been decreased and determine if using different coding paths based on improved, more detailed documentation can mitigate those decreases.
Health care organizations on top of these trends can use all of this information to understand, for example, which physicians might be at risk for under-reimbursement because they aren't documenting their work thoroughly enough, and correct that issue before the ICD-10 transition.
Delay could back-burner ICD-10 transition
Some hospitals will procrastinate on ICD-10 planning, which could snowball into revenue problems, said Pam Wirth, president of the coding, compliance and quality division at Amphion Medical Solutions, a company that provides ICD training and transcription services. Her company employs coders; as part of ICD-10 services implementation, she said Amphion has had to pay a 30% to 40% premium for using ICD-10 end-coding contract services, even though those services aren't yet being used and won't be until Oct. 1, 2014. Wirth said this is a very real cost of the delay for some health care providers and their partners.
C-suite hospital leaders still don't grasp the full implications of the new billing and coding language.
"The contract was signed, what are you going to do? I think a lot of people were ready to go [for Oct. 2013]; they had a plan in place," Wirth said. "I think some said, 'We're going to use the time to do other things.' I don't know that there was a whole lot that was gained from the delay, from the HIM perspective."
Her colleague Betty Schulte, Amphion coding manager, oversees a team of coders preparing for ICD-10. Her team's biggest challenge in ICD-10 implementation? "The decrease in production in order to cross over from ICD-9 to ICD-10. I think that's going to be a global problem in the health information management field."
She hopes, however, that time invested on the coding side in ICD-10 will help reduce claims questions from payers downstream, which coders presently must answer with ICD-9. The deeper documentation and specificity of codes in ICD-10, Schulte said, will leave much less ambiguity for payers in regard to diagnoses and care provided.
Other hospitals not ready
M*Modal Chief Scientist Juergen Fritsch said many of the company's customers are relieved by the year delay on ICD-10 implementation. And those who aren't relived haven't yet realized how huge of an undertaking it will be. For instance, two M*Modal clients -- large, well-known health systems -- don't have access to a lot of their own clinical documentation: Even though it's been digitized, the paper is scanned to image PDFs, which don't have searchable text.
M*Modal, he said, is spending time explaining basic concepts to its customers to prepare their data so they can use M*Modal's software to support ICD-10 coding and meaningful use reporting -- even though that's traditionally a little off-topic for the vendor.
When the Centers for Medicare & Medicaid Services (CMS) finally does flip the ICD-10 switch, Fritsch believes there will be a transition period where ICD-9 will still be dominating the back-end systems both for payers and providers. That will be a messy period.
"It's just going to be a game," he said. "For the sake of sending [a claim] to the government, it will be in ICD-10, who will translate it back down to ICD-9 again. It will be some time before we get true ICD-10-to-ICD-10 interaction."