Let us Measure ICD-10’s Progress in 2015

We, the healthcare providers, all waited with bated breath as the October 01, 2015 drew close – the day when our systems would transition from ICD-09 to ICD-10 coding system. The blogs and articles tried to draw up as many resources as they could to help healthcare providers get more aware of various gaps, pitfalls, the advantages and the disadvantages that the transition would bring. The most dreaded of all the changes that ICD-10 coding system would bring was drummed in – increase in denial claims leading to a fall in the revenue cycle.

Websites and blogs were full of the crossover charts and complex codes that would now be implemented, how some modifiers earlier arbitrarily employed would result in greater problems than just rejected claims, how specificity was now going to be much in demand and how automation and documentation were the keys to a successful Revenue Cycle management.

The implementation of ICD-10 and its transition smoothly transpired without a murmur. An 80 percent success rate for the transition from ICD-09 to ICD-10 was confirmed by a recent report. According to the Advanced Data Systems Corporation (ADS), a 99 percent success was ensured of over a million processed claims. This says a lot about the steps taken by many healthcare providers to ensure the smooth transition through the year 2015. In retrospect what really happened to ensure this smooth transition from ICD-09 to ICD-10 coding system.

  1. The Department of Health and Human Services (HHS) in February 2015 announced to tie 1 in 3 traditional Medicare payments to value-based outcomes by 2016 year end. HHS also declared an innovative goal for 85 percent of fee-for-service payments to be value-based. This immediately brought a change – greater focus on patients was beginning to bring back the spirit of healthcare practitioners who now saw their calling once again in demand
  2. Many healthcare providers spent significant time and resources implementing Electronic health Records (EHRs) to integrate the new payment models that the CMS was pushing along with the Obamacare or Affordable Care Act goals.
    1. CMS and other crucial sites to whom many healthcare providers turned to for updates ensured that information about what ICD-10 coding entailed was presented in a simple manner. The pros and cons were well mentioned, so that healthcare providers across the medical spectrum would be able to apply and imbibe the requirements as per their needs
    2. Webinars and workshops to train staff- front office trained for insurance eligibility and verification, coders, billers, and physicians on the new codes and their applicability to patients was the topmost on their lists. Training sessions were conducted and online information made available to all specialists with respect to the dual chart coding
    3. Contracts with vendors and payers were relooked at to ensure that all parties were in sync with the ICD-10 coding practices and documentation
    4. Software testing and claims submission and rejection workflows were put to strenuous testing regime
    5. Although, a month before the Oct 1, 2015 deadline, CMS issued a guidance allowing the processing of unspecified ICD-10 codes, but only for a year (through service on and prior to Sept. 30, 2016), brought some relief, yet many healthcare providers did not shelve the momentum of change

Thus, based on CMS’ release of claims data for the period Oct. 1-27, 2015, rejections rates for the period after the ICD-10 implementation equaled or were less than the historical baseline. This evidence shows the challenges of the ICD-10 implementation and the measures taken helped made the process a success.