ACA Compliance / Health Care Reform: ICD-10 Implementation Updates

Doctor with stethoscope in hand and electrocardiogram on green background

Much ado has been made about the ICD-10 implementation that’s currently taking place. And while it may be confusing to keep up with all of the changes that have been taking place since ICD-10 was voted to be implemented, this blog post will attempt to clear up any confusion about the implementation. This blog post will also discuss the findings made by professionals in the field about hospitals who have indeed adopted the ICD-10 implementation. Finally, this blog post will give some key steps necessary for those who haven’t fully adopted the implementation to go forward with doing so.

ICD-10: Implementation Findings

AppRev is one of the most respected outlets in the healthcare industry, and they recently did an extensive study into several hospitals who implemented the ICD-10 changes in the first quarter. The study came out with seven major determinations:

  1. On average, none of the hospitals showed any significant difference in the cash on hand after the ICD-10 implementation.
  2. Those patients who were discharged, but not “final billed,” showed a small increase in the month of October, but December showed the levels having returned to pre-ICD-10 levels. This suggests, like the previous finding before it, that so far, the implementation of ICD-10 doesn’t show a significant disruption in the day-to-day operations of the hospital.
  3. Many of the hospitals that were reviewed for the study reported that they were prepared for the transition to ICD-10. The trick, they said, was to prepare everything in September so that when October came around, and ICD-10 had to be implemented, they were ahead of the curve.
  4. There was no significant change in accounts receivable in the reporting hospitals throughout the change and the implementation period. Again, this suggests that there was little, if any, disruption in the day-to-day operations of the hospital during the process of implementation.
  5. There was also no significant change in authorization denials. The study’s leaders, however, suggest that this is because there was a greater level of cooperation between the service providers and the hospital, not because there was little to no disruption in the day-to-day operations of the hospital.
  6. There were some providers — namely, Florida Blue — that reported that they allowed those authorizations provided in March to “come through” in October. In other words, if the authorization was provided under the ICD-9, some providers allowed it to continue to be authorized under the ICD-10.
  7. Finally, but certainly no less importantly, there was definitely one area where the implementation of ICD-10 saw a significant change: there was a drastic increase in medical necessity denials. Many hospitals reported that there was nearly a doubling of the medical necessity denials around the implementation of the ICD-10. The study suggests that this is because many of the errors in Medicare coverage.

A more detailed review of the findings can be found here.

ICD-10 Implementation: Continued Implementation

While many hospitals have, luckily, not experienced extensive disruption in their day-to-day operations thanks to ICD-10 implementation, the following is a list of suggested steps that hospitals should take in order to continue successful implementation of ICD-10.

  • Create a baseline to set the standard, then supersede the standard. The only way hospitals can see how far they’ve come in the ICD-10 implementation is to set a baseline standard, then monitor their progress internally in order to continue meeting — and, ultimately, superseding — the standard baseline.
  • Address any feedback on any ICD-10 implementation, then work to make any changes necessary. While ICD-10 is proving to be successful, it will not be without its challenges (especially in older systems). Be sure to listen to your employees’ feedback about the implementation, and if there are any changes that need to be made, make them immediately to ensure a smoother transition.
  • Finally, but certainly no less importantly, make sure that your computer systems are up-to-date in order to ensure smooth implementation. Older systems will find it much harder to upgrade to the ICD-10 system than newer systems, so the investment into new systems in order to be ICD-10 compliant may prove to be a worthwhile investment. ICD-10 Implementation: How to Resolve ICD-10 Implementation Issues

Finally, but certainly no less importantly, it’s absolutely essential to be able to resolve any ICD-10 implementation issues in a quick and efficient way. The following, then, is a list of ways that any hospital can resolve any implementation issues in a quick and efficient way, should the need arise:

  • Establish KPIs (Key Performance Indicators) to assess the progress of the ICD-10 implementation, and then periodically make sure that you are reaching, or exceeding, your KPIs. If you are not, it will then be easy to determine where the failure to reach your KPIs lie.
  • Create an easy-to-follow communication system so that all employees can quickly, and effectively, communicate any failures in implementation and in the system. This will allow for greater responsibility site-wide in order to make implementation that much easier, and it will allow for all employees to monitor progress in implementation.
  • Be sure to compare all pre- and post-implementation documentation to make sure that everything is present and accounted for. The last thing anyone needs is the integrity of the data to be compromised as an end result of new system implementation.
  • Finally, but certainly no less importantly, any problems that are specifically related to Medicare and/or Medicaid should be addressed by contacting the Medicare-specific providers listed here. For more information about us and our services, contact us today.

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