By definition, ICD-10 is short for “International Statistical Classification of Diseases and Related Health Problems, 10th Revision.” On October 1, 2015, ICD-10 will replace the current classification system, ICD-9. At that time, ICD-9 codes will no longer be accepted on claims. Claims with ICD-9 codes after October 1 will be denied without payment, which means that familiarity with ICD-10 is all that more critical.
ICD-10 codes are longer and medical procedures will include much greater detail. Under the current ICD-9 codes, there are approximately 13,000 codes. When ICD-10 is implemented, more than 68,000 codes will be in place. The obvious advantages under the new system will be that ICD-10 is expected to be more specific, and consequently resulting in more accurate medical billing for practices.
The problem has been for the readiness regarding the ICD-10 transition, for it widely varies. Just over one-fifth of the providers responding to an early 2015 Navicure Survey said they were on track for switching to ICD-10, but the majority (81%) were optimistic they would be ready by October 1. There is still a great deal of skepticism and concern regarding ICD-10, especially as it relates to the effect it will have on cash flow and medical billing. It’s the “great unknown.”
Per the ICD-10 transition, what exactly can medical practices expect?
A 2014 survey by AHIMA and the eHealth Initiative found that close to one third of providers believe their medical billing will be adversely affected from the ICD-10 transition. An increase in claims error rates are expected to significantly increase during the ICD-10 transition, reaching levels of 6% to 10%, as compared to the approximately 3% error rate with ICD-9.
Due to the fact that the new coding system will be definitively more complex and because coding specialists will have to overcome a higher learning curve, providers can expect their medical billing cycle to significantly slow down, at least in the early stages. Time spent in accounts receivable are expected to increase as well. Consequently, it’s crucial that providers spend the necessary time to prepare their medical billing teams for the transition and to be ready to investigate high volumes of claims denials, and to be able to determine the root cause for them.
What does all of this mean for coding specialists?
Claims denials will be less likely will be less likely to be addressed by non-clinical medical billing staff under ICD-10. Rather, under ICD-10, denials are more likely to be centered around medical documentation and medical necessity and will need to be addressed by physicians or nurses. ICD-10 will require the coding specialists to be able to understand the more complex and specific aspects of clinical procedures as compared to what they were required to know under ICD-9. As far as the time element, a 2012 study found that on average coders took 15-18 minutes longer to code a record under ICD-10 than under ICD-9, which makes it even more vital that medical office personnel be thoroughly trained before the transition.
What will be the impact on physicians?
Under ICD-10, physicians will play a much more significant role in denials management. Not only must medical billing staff understand the depth, types, and complexities of information they will have to provide for claims to be processed, but physicians will also have to be ready to add their clinical input when inevitable denials occur, especially in the beginning of the transition. Practices who have had a good track record in denial management procedures under ICD-9 may find those procedures inadequate after the ICD-10 transition, and change accordingly.
During the transition process, practices will need to control the daily documentation burden on physicians in order that they can provide sufficient time to treating patients, and that there is no compromising. Some facilities do this by employing medical intelligence systems that create templates or criteria to help steer doctors through the documentation necessary to support procedures or diagnosis codes under ICD-10.
How best to ensure readiness for the ICD-10 transition
A 2013 Healthcare Financial Management Association document on preparing for ICD-10 presents a checklist that facilities can use to promote readiness for the transition.
Θ Understanding existing trends in denials under ICD-9
Θ Tracking progress in denial management technology adoption
Θ Making baseline measurements of efficiency and accuracy of coding and clinical documentation
Θ Identifying high dollar or high frequency procedures most at risk for claims denial and addressing those risks
Θ Identifying and addressing problems with the denial resolution process
Θ Investigating technology for coping with denial management
Θ Assessing financial resources available to work as a backstop should claims denials spike after the ICD-10 transition
The final analysis
Under ICD-10, medical billing will require more information, accuracy and training than that which was required under ICD-9. However, although there will be a greater learning curve, ultimately, the ICD-10 transition will ultimately enable a new generation of healthcare analytics that – theoretically – should provide better patient care and greater delivery efficiency. ALL those employed within a medical practice or hospital…..from frontline medical billing staff, physicians, nurses, and healthcare executives….must take the necessary steps to prepare for the changeover in order to minimize problems and claims denial.
With our cloud-based system and team of professionally trained coders and billers, MDofficeManager has the ability to offer full-service medical billing, transcription, and technology for healthcare providers throughout the country. Currently we have clientele in 34 states, and are ever-expanding. With expertise in all aspects of the medical billing cycle, MDofficeManager, located just across from Louisville, KY, is ready to assist individual physician practices, hospitals, and healthcare systems to best prepare and train for the inevitable challenges presented from the transition of ICD-9 to ICD-10.