5 Ways to Use the ICD-10 Delay to Create a Competitive Advantage for Your Health System

My Folder

ICD-10 delayIn April 2014, Congress gave the entire healthcare industry in the U.S. a reprieve — a one-year ICD-10 delay before providers will be required to document care using ICD-10 codes. The new deadline is October 1, 2015.

The experience reminded me of being back in school and having the teacher announce that a major test was being postponed a week. But in this case, there was a collective sigh of relief clear across the U.S. from a large group of care providers.

The question now is, what will health systems do with an extra year to make the transition to using ICD-10 codes? There will be a temptation to react like we may have back in school by turning our attention to other priorities until the night before the new test date. After all, health systems still have other mandates and initiatives they need to implement.

My recommendation, however, is to proceed as though the ICD-10 deadline will still happen this year — especially for organizations already well on the path to completion of the conversion. If there’s already a plan and timetable in place, and the resources allotted for it, don’t shift priorities. Being ready early will offer several competitive advantages. Here are five reasons why health systems should proceed as though there hasn’t been an ICD-10 delay.

1.  Coders need time to learn how to code with ICD-10 codes.

There is no way around the fact that there will be a large learning curve in making the switch from ICD-9 to ICD-10, especially with the increase in the number of codes.

ICD-9 uses around 13,000 diagnosis codes, most of which are fairly general. When ICD-10 is implemented, the number of diagnosis codes will increase by more than five times to about 68,000. Coding will also go from using 3-5 numbers to up to as many as 7 alphanumeric characters. That is no small adjustment.

The reason for the expansion of codes is to add greater levels of specificity, which will result in greater accuracy for managing various patient populations and submitting claims data. For example, rather than indicating a patient received treatment for a shoulder dislocation, as currently happens under ICD-9, the new codes will have separate codes for left and right shoulders. With more specific codes for each ailment, there should be fewer denied claims and better analytic opportunities.

Even though more codes will eventually improve care and streamline processes, the increased range of codes means coders will have a steep learning curve. The learning process will be time-consuming and not something easily done overnight.

2.  Dual coding with ICD-9 and ICD-10 codes enables early rewriting of reports and the discovery problems.

By moving forward with your ICD-10 plans, organizations will have the opportunity to perform dual coding, i.e., using both ICD-9 and ICD-10 codes. While this approach may require additional time and resources, it also provides the opportunity to find the variations in the codes which will help make for a more orderly transition.

Early rewriting and comparison of reporting is a key benefit of using both the ICD-9 and ICD-10 codes for the next year. For example, currently quality reporting to various agencies is generated using ICD-9 codes, but many of those reports need to be rewritten for ICD-10. Hospitals typically run thousands of reports, many using diagnostic and billing codes, so getting an early start on identifying which reports need to rewritten and making the necessary changes will be important.

This rewrite will involve updating significant numbers of ICD-9 codes. While available mappings may be a useful starting point, all of the reports will need to be validated. A good way to accomplish that is with actual data that directly compares to the ICD-9 version of the report. As the reports are developed in ICD-10, you will be able to compare them to the old ICD-9-based reports, determine where the differences or problems are, and make changes before revenue and compliance depend on the reports.

Continuing to work as if there is a 2014 deadline will allow any issues to surface, whether they are with the way the reports are written or the way the coders have been trained. Then it’s possible to test various course corrections before they’re disruptive to the business. The more experience health systems have by October 1, 2015, the less impact the team’s coding processes will have on the bottom line.

There’s one more caveat to keep in mind: it’s possible that not all payers will be able to immediately start consuming ICD-10 codes, in which case dual coding may be necessary for a period of time anyway. Take this time to get good at it.

3.  ICD-10 codes in the EDW can be used to improve analytics and provide a 2014-2015 comparison of data.

If health systems start storing ICD-10 data in their enterprise data warehouses (EDWs), they can use this data to test and improve their analytic capabilities. For example, once data in the enterprise data warehouse (EDW) is in the new ICD-10 format, analysts will be able to build new, more informative dashboards to take advantage of the higher level of detail because the data in some clinical areas will be much more specific.

There’s another benefit to bringing ICD-10 coded data into the EDW now: analysts will be able to use the data as a baseline for a year-by-year comparison when ICD-10 does go live in 2015. It’s not necessary to use the 2014 data for actual reporting or claims submission, but having the data on hand will make it possible to see trends more easily and save time from trying to piece together the information retrospectively.

4.  Health systems will be able to more accurately project the financial impact of the transition — and even budget for it.

Many executives and experts are expecting payments to be delayed as both providers and payers work through the issues of transition from ICD-9 to ICD-10. Dual coding now will provide a better opportunity to project the impact the transition will have on revenue, at least in the short term, and plan for it.

By calculating early estimates about what the delays might cost, it’s possible to build a cash reserve to help the organization better survive the transition period. With all the revenue pressures providers are already facing, anything that can be done to avoid additional financial losses is a smart move.

At the same time, there may be some differences in payments when coded in ICD-10 versus ICD-9. That will also be good to know in advance so health systems can plan (and budget) accordingly.

5.  Payers are learning too, opening up new opportunities for improved relationships with providers. 

While there is often an adversarial relationship between providers and payers when it comes to claims, it’s important to keep in mind: the ICD-10 transition is new for payers as well. They’re dealing with many similar challenges to health systems:  re-writing their auditing algorithms, re-training their personnel on what constitutes complete and accurate coding, and making other adjustments.

Instead of perpetuating the traditional, adversarial relationship, health systems and providers could benefit by working together and helping each other. For example, some larger payers are either ready or nearly ready to begin accepting ICD-10 coding for test purposes but they’re having trouble finding health systems that are prepared to submit data. By delivering the ICD-10 coding to them now and uncovering the difference between the ICD-9 and ICD-10 submissions, the health system will be able identify issues early and possibly correct them. The payer will also be able to provide feedback about how the new claims are being adjudicated, which can be used to train personnel to avoid the denial of future claims submissions. This can be accomplished without rushing or incurring significant overtime costs.

Get Ahead, Stay Ahead

If you are already well on-track to transition to ICD-10, my advice is to stay the course; continue those efforts, so there’s have plenty of time to test, adjust, and plan for issues (such as delayed payments) that are beyond anyone’s control.

On the other hand, if meeting the 2014 deadline was going to be a struggle, take a deep breath. Just view the ICD-10 delay as a reprieve of sorts and use the extra time to prepare to meet the challenges head-on.

Are you using this time to get ahead?  If so, what are you doing to take advantage of the ICD-10 delay?  If not, did this article give you some good ideas?

Loading next article...