ICD-10 problems persist for some healthcare providers

For all the general characterizations of how ICD-10 is impacting healthcare provider productivity and revenue cycles since its implementation on October 1, reports from the field show a range of experiences among hospitals and health networks adjusting to the new medical and diagnostic coding system.

While some physicians reporting their early impressions to Medical Economics say the ICD-10 transition has gone smoothly, others cite ongoing problems.

A family practitioner in California reports glitches with his EHR’s ICD-10 search engine, as well as coding issues with IDC-10 descriptors in the EHR that are hard for patients to comprehend.

But another family practitioner, this one in Maryland, reports that “we have had no problems in getting the claims submitted and paid,” Medical Economics writes.

And while an optometrist in the Golden State sees no problems with ICD-10 in her practice, she also sees no benefits. “So far, it is at least manageable, but it is difficult to see that it is any advantage to anyone,” she says.

For the period Nov 1 – Nov 23, Relay Health’s ICD-10 Central tracker reports a very slight increase in denial rates (up to 1.7 percent since October 1, compared to 1.6 percent in August and September). Reimbursement rates are also down slightly to 28.4 percent in November, compared with 28.9 in August and 28.6 in September.

The differing experiences regarding ICD-10 can be attributed to a number of things, including how well providers have trained and prepared staff, how well their EHR vendors integrated ICD-10 into their systems, and how lenient payers have been to date with submitted claims that might have coding issues.

For providers struggling with ICD-10, it’s important to locate the sources of any issues as early as possible so they don’t snowball into problems that hurt the revenue cycle and employee productivity.

Jason Williams, RelayHealth’s vice president of strategy and business analytics, recommends applying analytics to claims data:

“Providers should focus on top denials, claims edit analyses, reimbursement trends, and payer performance. Drilling down into this data can help trace errors that impact the revenue cycle back to the source – a particular clinician, coder, code or procedure.”

It’s also important for providers to understand how their performance compares to industry peers. RelayHealth’s ICD-10 Central allows providers to track four revenue cycle key performance indicators (Days to Service; Days to Payment; Denial Rate; and Reimbursement Rate) for the prior three months, the current month to date, and the previous seven days. Providers can view data by healthcare specialty, bed count, and region.

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