So, we reached ICD-10. Now what happens?
Few issues have dominated healthcare over the past several years more than ICD-10. The angst and gnashing of teeth that so many in our industry displayed when it became clear that ICD-9 finally would be laid to rest now seems like one part Chicken Little and one part Y2K.
In my first interview with Amy Amick, President, Revenue Cycle Management and William Davis, Vice President, Revenue Cycle Advisory Solutions at MedAssets, we learned how their teams and healthcare partners worked together to prepare their partners for the ICD-10 transition in October.
In this follow-up conversation, we discuss how healthcare organizations ought to proceed now that ICD-10 is the new normal for the industry.
Free: We are two months past the October coding transition. Are you hearing that, more or less, the sky won’t be falling now that ICD-10 is a reality?
Amick: I hear a lot of things, but the highest consensus that I am hearing from the providers is that they have done the best they can to be ready, and that they are now spending their time and effort on making sure that they have ways to react to the problems that might arise moving forward. It seems as though many have wisely used the extra time provided by the extensions to prepare for ICD-10, but there still may be problems to follow.
Whenever you introduce change, there’s a natural inefficiency to expect for a period of time. If a task usually takes 30 seconds, while I’m going through a change, that activity now might take me 45 seconds. If you multiply that difference due to a greater change and a greater volume like ICD-10, you could have significant inefficiency.
I hear providers talking now about this point, and they have switched their focus from “How do I train my people?” to now making sure that they have their responsive actions in place and working well. They are asking themselves, “How do I make sure that I am planning for overtime in the coming months because my people, for the first time, will be using a new set of codes and a new set of modified processes and decision making? How do I make sure that I’ve got the necessary labor support in this initial stage?”
I recently worked with an organization who created a set of “what if” scenarios. One of their scenarios centered upon how would they operate if they encounter a denial because of x, y or z. How do they make sure that they have their staff ready, not just to make the change to defend against that denial and to fix that challenge that may result from the coding error, but how do they also have a targeted readiness plan to go back and see what the root cause of that particular denial was? Also, how will they go back to train whomever might have made the coding error up front that resulted in a denial or what not? So, not just reacting to, “How do I clean up, address, resolve issues in a tactical way, but how do I actually have pre-programmed ways to go back and refresh training, modify processes, etc. to do any responsive action that may have to come post-change?” These scenarios are no longer hypothetical. They are our partners’ realities today.
Davis: Amy, you brought up an important point there around the denials.
I think in the coming weeks, even with all of the training and planning that has been done, there are going to be challenges, obviously, in denials, cash flow and claims payments. Clearly, when going from ICD-9 to ICD-10, the complexities and the volume of considerations go up five fold. That complexity, coupled with the volume of claims, is going to cause a disruption in claims payments for a bit of time to come. So, looking at that just kind of front-on, I think everyone is aware of that and are prepared to meet it.
Conducting a root-cause analysis and then corrective-action planning is very important, but there could be a couple of blind spots that maybe providers aren’t thinking about even now that ICD-10 is here.
One such blind spot can be within a clinical documentation improvement program. Many providers are going to rely on an encoder for accurate bill creation, however that’s not necessarily going to flag mischarges or misdocumentation. Having a hands-on program and a bird’s-eye view of what’s actually happening within the documentation and the claims creation is critical.
Another blind spot might be in the upstream processes, even further upstream than clinical documentation improvement and coding, within the patient access part of the operations. Current estimates are around 50 percent of denials are preventable with proper registration. Prior authorization, certification, determining medical necessity all have to happen at the point of service, or even before the point of service. That, I think, is a blind spot for some today. Everyone’s looking at the claims and the adjudication and the payment, but you have to look at the extended processes outside of that too.
Those are two areas that I think will garner more focus by the providers over the coming weeks.
Amick: One more thing to add that I do hear regards when one of customer’s fiscal year ends. If their year-end was closer to October versus further from October, I hear a different sense of anxiety, or trepidation. They understand that there may be a transition period where denials are higher, or payments might lag as they go through this change. If someone’s fiscal year ended much closer to October, I hear more anxiety from them about the relevance of having the time to digest the transition period versus not.
Free: How are things going to change in terms of support? There’s a big difference between training and planning before ICD-1o and the training and planning to execute ICD-10 as the new normal. What will be the sorts of services and support that will be needed as we move in 2016?
Davis: We have five levels of readiness at MedAssets: our formal planning or product readiness, data consumption, validation, internal training of our personnel and then support and production.
Providers will need immediacy of support should a problem arise. If there is a vulnerability identified either through a denial-payer edit, a claim’s submission, training, or coding errors, the immediacy and the necessary turnaround time is going to be heightened. That’s what we have been preparing for to ensure that our clients’ experience a successful transition.
It’s not only immediacy. It’s also completeness. If there is a problem, you must correctly and thoroughly identify that problem. You don’t want to just fix the symptoms because that will just perpetuate the problem. So, it’s immediacy and completeness that we plan to offer our partners in terms of providing support moving forward.
Amick: On a different level, there are three ways from a business perspective that MedAssets supports the needs that our partner organizations could have in the next few months.
First of all, we offer technology that helps automate workflows. Second of all, we’ve got a larger consultancy practice that helps practices to improve workflow process and adoption of change. And then third, we have a team that can provide outsourced revenue cycle service on behalf of our customers. That extra support can either be in a permanent fashion, or in an interim staff-augmentation fashion.
Today, we are seeing some follow-up fine tuning and reassessment from a lot of different decision makers in these organizations. We, at MedAssets, are helping our partners to modify their processes and systems so that they can achieve a greater speed of optimal performance.
It’s been quite a ride and it’s not over. However, I know that our preparations, planning and support are going to get us through this monumental transition.