by Carl Natale
Posted on Sat, Mar 15, 2014 - 11:03 am
The University of Illinois has released the misunderstood study of the year. And I'm pretty sure it's going to be hard to beat the rest of the year.
To get an idea of how challenging the ICD-10 transition will be, researchers chose 120 ICD-9 codes from the Illinois Medicaid database used by hematology-oncology physicians. These represented the highest reimbursements. Researchers also used the 100 most-used codes from the University of Illinois Cancer Center.
They then ran the ICD-9 codes through a conversion tool developed at the University of Illinois Chicago to get ICD-10 codes. That yielded the following results
"The transition to ICD-10-CM led to significant information loss, affecting 8% of total Medicaid codes and 1% of UICC codes; 39 ICD-9-CM codes with information loss accounted for 2.9% of total Medicaid reimbursements and 5.3% of UICC billing charges."
This has inspired many headlines citing a link between ICD-10 coding and information loss.
Except that's not what this study shows. What this study does show is that relying on automatic mapping tools or translators will result in a reduction of information and reimbursements.
I wonder what the results would have been if the original medical records were coded. It would have been interesting to see the change in information and reimbursement then.
If the reimbursement levels increase at all, would it make up for the added cost of re-coding? Or would it be more cost effective to stick with inferior mapping tools?
That would be a really interesting study to see.
Dan Riskin, MD, CEO of Health Fidelity, makes the case against ICD-10 data:
- Medical claims data can be inaccurate. Even if it's accurate, it isn't robust enough.
- SNOMED has the granularity.
- Small hospitals could use ICD-10 data for revenue analysis. But more robust data is needed in larger organizations.
The American Academy of Family Physicians (AAFP) surveyed major health insurance companies on ICD-10 preparedness. The AAFP found that healthcare payers:
- Said they were collaborating with larger clients first.
- Said they offered resources for physicians.
- Placed a lot of value in testing.
- Were concerned by healthcare IT vendors' state of readiness.
- Were willing to share information about ICD-10 test findings with healthcare providers in their networks.
Barbara Aubry notes that healthcare providers already are having problems coding claims properly. It's not going to be ICD-10 coding that will be to blame for all the reimbursement problems. (3M Health Information Systems)
John Halamka, CIO of Beth Israel Deaconess Medical Center (BIDMC) in Boston, had some key takeaways about the ICD-10 implementation:
- There is concern about what recovery audit contractors will find after Oct. 1.
- BIDMC is doubling its coding staff because Halamka feels there will be a permanent 50 percent productivity loss.
- The expansion of codes has given Halamka a good reason to build an electronic documentation system.
- “We were passing 835s successfully. So far so good. We can mechanically pass a code but whether the code is accurate, relevant or auditable--that’s a totally different problem.”
NueMD is surveying healthcare professionals’ attitudes regarding the ICD-10 transition. (NueMD)
Samuel Ambrose has 15 questions for electronic health record (EHR) and practice management software (PMS) vendors to gauge their ICD-10 preparations. (Physicians Practice)
- Decide who needs what training
- Create a training plan
- Start training ASAP
- Make practice a part of your training
- "What software requires updates or needs to be replaced in order to accommodate ICD-10 codes?"
- "If you have already made these upgrades, is it available for testing internally?"
- "Have you worked with your vendor and IT staff to set up a test environment that mimics the production environment?"
- "Do you have accurate data to test with? "
- "Have you performed internal testing to verify you can submit a claim in ICD-10?"
- "Do you know what payers and clearinghouses you need to test with externally?"
- "Have you checked payer websites for information about their ICD-10 testing initiatives?"
- "Will you be able to test with all your payers or only a select few? If you can’t test with all the payers, do you have any peers that are planning to test with those payers/clearinghouses and are willing to share some of the results?"
- ICD-10 implementation has a lot of moving parts that encompass more than technology.
- Non-compliance definitely will stop reimbursement. But there could be revenue issues even with ICD-10 compliant medical claims.
- "Determine what’s “absolutely critical” for your practice."
- "Focus on documentation."
- "Find out what your vendors are doing."
- "Figure out what your health insurers are doing."
- "Test from end to end."
Unintended ICD-10 Consequences: Inadequate Clinical Documentation Can Negatively Impact Physician Profiles
- Incomplete documentation can lead to undercoding.
- Undercoding can cost healthcare organizations in lost reimbursements.
- Undercoding can also affect physicians' performance assessments.
Answers to two common ICD-10 questions:
- Why can’t we stay with ICD-9-CM?
- So what’s so great about ICD-10?
Basically, reimbursement disruption can hurt a hospital's credit rating. (FitchResearch)