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Financial impact of ICD-10 transition hard to ignore

Even with the best laid plans, the ICD-10 transition may be rough for providers. To minimize the financial impact in the months after October 2013, place pressure on payers.

Considering all the software that supports the ICD-10 transition, it's easy to forget that it's actually a language, and not a product itself. The transition will be one of process and workflow, with the technology supporting the changes it will require.

"If I were to summarize the ICD-10 challenge in a few words, it would be increased granularity of clinical information that's required," said Nuance Communications Inc. CMIO Nick van Terheyden. "The only place you can fix that, realistically, is at the point of creation of clinical documentation. If you can't fix the capture at that point, you're not going to be able to fix it downstream."

Speech recognition and natural language processing engines will be key technologies to aid coders using ICD-10, van Terheyden said. He added that Nuance has been able to greatly improve its speech-recognition capabilities thanks to a free Dragon iPhone app. The voices and data from its large, diverse user base helped engineers more quickly "train" the next version of its products.

Despite all the tools, technology and training a hospital can do, there still could be difficulties in switching over to ICD-10. Several HIM managers and vendors echoed what others said at the recent Health Care Compliance Association conference -- hospitals are advised to prepare their finance department to manage longer accounts-receivable cycles and open new credit lines to weather what could be a rough transition.

ICD-10 transition bringing upheaval to claims processing, prior authorization

Some of the experts interviewed said that even facilities that execute well-planned ICD-10 implementations could still end up in a financial disaster scene, with months of chaos following the ICD-10 transition date.

And whose fault might it be? One expert at the Health Care Compliance Association's (HCCA) New England Regional Conference worried that payer organizations slow in making the ICD-10 transition could cause hospital accounts receivables to extend dangerously. Some payers, such as the 635,000-member Tufts Health Plan run skeleton crews in their coding departments in comparison to hospitals, Tufts Health Plan Director of ICD-10 implementation and infrastructure initiatives Patrice Devoe said at the HCCA conference.

Anecdotes like these and others heard on the floor at AHIMA fuel providers' fears that payers won't be prepared to sort out issues in denied claims. The lack of payer ICD-10 bandwidth can only increase the number of denied claims, the logic goes, as coders employed by providers and payers together get used to the massive ICD-code set, which is five times bigger than ICD-9.

The ICD-10 transition also stands to further complicate prior authorization.

Don't plan on payers being able to answer ICD-10 questions, Linda Howrey, principal compliance consultant for Hayes Management Consulting, said at the HCCA conference. "They are not your resource for coding," said Howrey, who helps hospitals design ICD-10 rollout plans as well as coordinates physician training.

The ICD-10 transition also stands to further complicate prior authorization for providers, since more ICD-10 codes means more diagnoses, treatments and procedures that require prior authorization, not to mention more opportunities for missing or incorrect information as payers process prior authorization implementations.  

"I don't believe the payers are going to be ready," said Carol Fowler, HIM director from the Gwinnett (Ga.) Hospital System. "We have to find ways to make sure they're after it."

The Workgroup for Electronic Data Interchange suggests in its ICD-10 transition timeline that providers should begin application and submission testing and remediation in early 2013. Their first calls to payers should be much sooner than that.

Site Editor Brian Eastwood contributed to this report. Let us know what you think about the story; email Don Fluckinger, Features Writer.

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