Posted by: Jenny Laurello
HIPAA, HIPAA 5010, ICD-10, ICD-10 migration, ICD-10 transition
Guest post by: Baskar Mohan, Director, Healthcare Practice, Virtusa Corporation
Transitioning to ICD-10 is a journey laden with challenges and pitfalls. If health care organizations aren’t cognizant of this fact, then their awareness of the implications of failure is limited. A well-planned approach is one of the key requirements for a successful migration, and taking into account the experiences from other hospital and health system implementations is a crucial first step in building your program execution plan.
Although HIPAA and ICD-10 are two different mandates, we can draw important takeaways from the challenges and issues faced in both respects. Based on our experience in ensuring HIPAA compliance, we believe there are a few key areas on which providers must continually focus before starting their ICD-10 program transition.
Highlighted below are the five mistakes providers must avoid during their ICD10 journeys:
- Proper usage of ICD-10 codes by physicians – It is critical to educate the hospital staff about the importance of proper ICD-10 coding and the impact it can have on a member’s welfare. An understanding by the staff of how the migration enables the physicians to have the right information, including the point of contact, greatly helps in member satisfaction.
- ICD-10 submissions – Providers typically see the ICD-10 implementation as another mandate that burdens the hospital. Because of this, providers tend to focus on meeting their requirements of satisfying ICD-10 claim submission. Instead, if a provider focuses more internally and identifies through proper analysis areas within the hospitals that can truly leverage the power of ICD-10 coding, then it will be great step forward.
- Revenue cycle management (RCM) & ICD10 – Most of the hospital’s revenue cycle management software vendors are ICD-10-ready. But “one solution fits all” may not be appropriate for all hospitals. Provider organizations should demand from hospitals a more focused roll out of the ICD-10 implementation that will improve their bottom line as well as their top line.
- Clearinghouse requirements – Providers should also use this opportunity to leverage the benefits of payer organizations providing direct access and incentives for direct submission of electronic claims. They should revisit the existing clearinghouses they currently use, and instead of fearing more rejection rates due to ICD-10, should actually start to reduce their dependency on the Clearinghouses.
- Provider contracts – Provider contracting seems to be an important area for providers more than payers. Even though most of the contracts are not based on ICD-10, it could definitely be a revenue loss for providers if they do not analyze the impact of ICD-10 on their future payments. The best way to avoid this pitfall is to review the history of submissions for the past year and identify key ICD-10 codes used and the payment outcomes for those claims.
There is lot that can be learned from observing other providers’ ICD-10 and HIPAA implementation challenges and successes. The more we try to understand and can learn from these experiences, including mistakes made, the better the chance of a successful ICD-10 journey.