Not trying to sound alarms here, but if experts we’ve been hearing out on the health IT conference rubber-chicken circuit have it right, the transition to ICD-10 in two years will be the equivalent of running a hospital into a brick wall. On the revenue side, that is.
Because of arcane rules dictating that discharge date for inpatients and date of treatment for outpatients dictate whether ICD-9 or ICD-10 will be used on a claim – before Oct. 1, 2013, use ICD-9, after, ICD-10 — there will be a period of weeks or even months when both languages will be in use. As in, some claims filed after Oct. 1, 2013 will use ICD-9 codes.
One would think that an absolute ICD-9 cutoff date would be simpler to implement, but instead we’ve got this. What a hassle. As HIM managers at payers and hospitals and outpatient facilities try and puzzle out how they’re going to cope with this one particularly thorny piece of the ICD-10 implementation, IT managers are taking stock of how many applications and departments ICD codes touch in general, and what software vendors are doing to flip the switch to ICD-10, and how they interoperate together (i.e. confirming they all working off the same ICD-9 to ICD-10 crosswalk maps; they handle both languages at once during the transition period; and the policies that govern the transition are updated, etc.).
Oh wait. Did we just imply that hospitals in general are working on ICD-10 implementation? We meant less than half. On the eve of the association’s yearly meeting in Salt Lake City, a new AHIMA survey of 448 hospitals indicates that 80% have begun assessing what kind of impact ICD-10 might have on their organization, up from 62% last year. But only 49% have begun acting on those impact analyses. 60% of respondents indicated they don’t even have an implementation planning (governance) team.
AHIMA hopes to provide its members with the justifications for bearing down on this ICD-10 work now to take back to their provider organizations’ senior leadership. Because if they don’t things could get ugly: A few weeks ago, at a compliance conference we attended, a panel of three experts cautioned attendees that this will be a much larger transition than anyone imagines, because so many IT systems and written policies at a health care provider organization touch ICD codes.
Even if a hospital starts ICD-10 prep now, the panelists agreed it’s almost impossible to see in advance just how many people and software applications will be affected by the switchover to ICD-10. On top of that, it’s impossible to predict how much of a delay it will cause in claims payment — as well to budget for the extra manpower it will take to get denied claims paid.
One expert said she estimates the transition period to ICD-10 will go from Oct. 1, 2013 to Jan. 1, 2015, and that hospitals that put more work into the transition now will suffer less of a blow than those that start later.
The expert sitting beside her likened the transition to ICD-10 as worse than the potential fallout doomsayers were predicting from Y2K.
Next to her, the third expert gave perhaps the soundest advice: This transition will be very bumpy — make sure senior hospital leadership opens up as many new lines of credit as possible, because ICD-10 will choke off revenue quickly, and it will only trickle in for a while. That might sound a bit like an outside-the-box ICD-10 preparedness strategy, but it underscores the profound impact this transition could have on much more than coders.