How to Avoid an ICD-10 Claims Disaster

Guest post by Michele Hibbert-Iacobacci, CMCO,CCS-P, vice president of information management support, Mitchell International.

Michele Hibbert-Iacobacci
Michele Hibbert-Iacobacci

Recent ICD-10 end-to-end testing conducted by CMS and the American Medical Association yielded an 87 percent claim acceptance rate. This means that of the 29,286 test claims received, only 25,646 were accepted. Imagine thousands of claims denied due to providers submitting improper codes, stalling the bill review process and creating pain for everyone involved.

The one percentage drop in claims accepted from the month prior is a poor indication for the months ahead, as 100 percent of the test participants claimed to be fully ready for the October 1 ICD-10 implementation date. It’s only logical that many carriers and providers wonder what will happen to those that aren’t ready.

The end-to-end testing results also raise complicated questions: Which ICD-10 codes will be seen most frequently post-implementation date? And will these codes match what providers will put on the bills they send?

It’s no secret that ICD-9 has a lot fewer codes than ICD-10 and a situation is simply less complicated with less contextual data to worry about. As a result of the influx of new codes presented by ICD-10, we can expect to see providers assigning way more codes than necessary to bills in a pin the tail on the donkey-type attempt to choose the right code. For example, there are ten codes for a fracture to the tibia in ICD-10, as opposed to one in ICD-9. So many options may lead a provider to place all ten on a bill, to ensure payment is received.

It will be challenging for untrained providers to submit the correct ICD-10 codes, and as such, productivity will decrease alongside increasing reimbursement challenges and potential claim denials. Carriers, on the other side, will be forced to conduct extensive reviews of each bill to determine the actual injury cause and appropriate code.

To handle the huge influx of ICD-10 codes, providers can design a system where the office coders are provided with quick references to the most prevalent codes used in the practice. Over time, the overall billing experience will improve as coders become more skilled in identifying proper codes and carriers become more precise in reviewing bills. At first, carriers will be tolerant toward the reporting of multiple or vague codes. However, with each passing day post-implementation of ICD-10 carriers will become increasingly strict. Providers will be required to submit correct coding pending the value provided by the classification system accurately describes patient conditions.

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Quick Training References and Refreshers for ICD-10

Michele Hibbert-Iacobacci, CMCO,CCS-P, vice president of information management support, Mitchell International.

Michele Hibbert-Iacobacci
Michele Hibbert-Iacobacci

With the October 1 implementation date for ICD-10 just around the corner, many providers are in need of a quick, at-a-glance refresher to their training. The implementation of ICD-10 has been delayed twice, so many providers that had solid plans for training in advance are not as prepared as they had intended to be.

Quick reference guides are in even higher demand considering the influx of codes required by ICD-10. Currently, ICD-9 includes 13,800 three to five digit, primarily numeric diagnostic codes. By contrast, the ICD-10 code set will contain roughly five times that number, totaling approximately 69,000 three to seven digit, alphanumeric codes.

To alleviate the last minute training scramble, ICD-10-focused readiness material and courses from widely accepted and well-known organizations may help ensure a smooth transition come October 1.

American Association of Professional Coders (AAPC) have go-at-your-own pace online courses for both ICD-10-CM and PCS.

Centers for Medicare and Medicaid Services (CMS) offer ICD-10 training and readiness resources for all providers, not just those billing the payer. and

American Hospital Associations Coding Clinic Advisor (AHA) is a forum where specific questions can be addressed.

American Medical Association (AMA) provides many resources including training which can be accessed on their educational site.

American Health Information Management Association (AHIMA) offers training resources that encompass the physician practice.

American College of Physicians (ACP) presents resources and information for accessing sites with training and primers.

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Impact of the ICD-10 Delay on the Property and Casualty Sector

Michele Hibbert-Iacobacci
Michele Hibbert-Iacobacci

Guest post by Michele Hibbert-Iacobacci, CMCO, CCS-P, vice president, information management and client services, Mitchell International.

The International Classification of Diseases – 10th Revision, Clinical Modification and Procedural Coding System’s (ICD-10-CM/PCS) implementation in the United States is being delayed yet again. According to the latest polls and surveys, there are many organizations (most who need to use it) that were ready to roll with the new classification on October 1st 2014. The change came about because the Senate approved a bill (H.R. 4302) on March 31, 2014, that delays the implementation of ICD-10-CM/PCS by at least one year and then a subsequent official announcement by CMS announced a forthcoming interim final rule that would set the new compliance date for October 1, 2015.

How will this new implementation date affect Property and Casualty payers and providers? For an industry that was not required to change, P&C was ready to go – mainly because of the dependency on payments and bill processing. The question was, “Will we see ICD-9 and/or ICD-10?”

Fortunately, from a processing perspective the P&C industry was prepared for most anything. Payers were creating processing systems and/or contracting with vendors who considered all possibilities including bills submitted with both codes and the submission of ICD-9 codes well after effective dates. These payers also considered the compliance environment as most are guided at the state level.

As difficult as it may be to be ready for the effective date of ICD-10 just to have it changed, most aspects are positive for property and casualty.  Additional time for testing, communication to providers and overall education (external/internal) enhances the readiness for the new date. The negative is the cost – staff has been added and enhanced with testers, educators and coders for the initial date. Maintaining staffing levels for a longer period of time was not accounted for in most budgets. The cost will be higher to implement now and many companies did not plan on the additional timeline.

So how will this shake out moving forward? Providers will likely react by submitting ICD-10 codes to P&C payers before the implementation date of October 1, 2015.  Payers will need to make decisions on how they will handle these claims since P&C is not guided by the same rules under HIPAA as the health side. Some payers may decide to turn these claims back to providers and others will translate to ICD-9 for payment. Compliance standards, whereby a state has implemented mandates on the use of code sets that need to be addressed and/or revisited, may also impact the way payers process ICD-10 codes prior to October 1, 2015.

Tips to Prepare for ICD-10, and For Boosting Coder Morale and Productivity

Michele Hibbert-Iacobacci
Michele Hibbert-Iacobacci

Guest post by Michele Hibbert-Iacobacci, vice president, information management and client services, Mitchell International.

Employee morale is a constantly at the forefront of the healthcare industry because of on-the-job stress, do more-with-less mentalities and a consistent cost containment focus. With the introduction of ICD-10, employees who work in healthcare as medical coders will be expected to maintain productivity and produce quality coding. We are changing the communication language used between payers and providers and have an expectation that everyone speak the same language as of a specific date.

Although difficult to attempt in a short time frame, this language change has been coming for many years and we should be ready by October 1, 2015. While the industry has been given more time to prepare, this transformation will still have an effect on the medical coding professional from a morale perspective, let’s face it – do coders know ICD-9 or what? Most have ICD-9 memorized so change will be a very new condition for the medical coder to deal with.

Steps to mitigate morale issues should be reviewed and/or introduced to minimize pushback and employee attrition. Skilled coding professionals are needed in the industry, they are valuable and the ICD-10 language barrier is one that requires specific steps to maintain medical coder involvement.

Having worked as a coder for many years, I can attest to the following as ways of boosting morale:

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How to Seamlessly Integrate ICD-10

Michele Hibbert-Iacobacci
Michele Hibbert-Iacobacci

Guest post by Michele Hibbert-Iacobacci, vice president of information management and client services, Mitchell International.

Seamlessly integrate ICD-10? How is that possible? Realistically, yes, ICD-10 is new and the United States will start to utilize the new code set effective October 1, 2014.

Is ICD-10 really new, though? Not really, and frankly many entities are so ready they are looking forward to ICD-11, which has a “who knows when” implementation timeframe.

Seamless integration of anything takes preparation. The best part of ICD-10 is that covered entities have started and stopped implementations twice prior to the impending October 1, 2014 effective date. In fact, we almost had a third postponement with proposed federal legislation called the “Costly Codes Act,” which today has a two percent chance of making it to committee and zero percent chance of passing. This bill has more than 35 sponsors, so it’s amazing that we are seven months from implementation and this type of delay is still being contemplated.

It’s likely the sponsors are not aware of where ICD-10 has been and where it is going. The 2014 implementation date was postponed because of providers not being ready for the program. A third postponement would be devastating to the entities that have prepared for all three implementation dates.

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