The ICD-10 transition might be headed for a bumpy road

Carl Natale
by Carl Natale
The ICD-10 transition might be headed for a bumpy road

After six months of using ICD-10-CM/PCS codes, it's getting harder to say we need more data on the ICD-10 transition. Perhaps we should be striving to get the right data, not more.

MedPage Today found enough to declare the ICD-10 transition an easy ride. Mostly.

This is largely based upon a RevApp study that included data from 40 hospitals for the first three months of ICD-10 implementation. There were six takeaways:

  1. The average for days of cash on hand stayed steady.
  2. The results for discharged not final billed (DNFB) spiked in October but came back down in December.
  3. The participating hospitals seemed to be prepared
  4. Accounts receivable cycles barely changed.
  5. Authorization denials barely changed.
  6. Medical necessity denials increased — almost doubling at some hospitals.

That increase in medical necessity denials was attributed to mistakes in Medicare national coverage determinations (NCDs). There have been efforts to correct those mistakes and reimburse fully.

It is important to realize that this rosy picture ends Dec. 31. Because a RemitData analysis shows denial rates and days in accounts receivable increasing since January.

Perhaps these are two small sample sizes that fail to offer complete pictures. It's enough data to suggest that medical practices need to run their own analytics and compare notes with other healthcare providers. Revenue disruption might be on the way.

But what is certainly on the way is an ICD-10 update in six months. Disruption could get worse if medical practices aren't prepared.