After three delays and much industry opposition, the United States' healthcare industry transitioned Oct. 1 to ICD-10, catching up with the latest version of the international classification of diseases codes.
The transition has been compared to the Y2K scare at the turn of the millennium, and it has largely experienced the same outcome: a relatively uneventful transition. While it is still too early to tell what the full effects of the transition are, most providers appear unperturbed by the transition.
Here, nine leaders share how the go-live went and what they expect in the coming weeks. Responses are presented alphabetically.
Jim Daley, Past WEDI Chair and Head of the ICD-10 Workgroup at WEDI: "It's early to tell much — it will be several more days until significant volumes of professional claims reach payers. Inpatient claims will take longer than that to reach payers, since it takes time to prepare final bills for inpatient stays. So far, reports have been positive, although there have been some issues reported with vendor software that was delivered last minute. Those issues might be related to not knowing how to use the product versus actual flaws, but those points are unclear at this point. There was another issue where a product expected all claims to use ICD-10 starting Oct. 1, not taking into account that runoff claims for services prior to Oct. 1 would need to be submitted using ICD-9 codes.
"Many of the questions WEDI has been receiving through the ICD-10 database are related to coding: How do I code for this or that, etc. In particular, use of the seventh character for initial encounter, subsequent encounter or sequels has been a point of confusion. Also, some have asked if new authorizations would be needed by payers if the prior authorization for services had been submitted under ICD-9. That would be dependent on the payer-specific processes and could vary by each payer."
Mark Farrow, Coding & Compliance Manager, Austin (Texas) Regional Clinic: "So far, the transition to ICD-10 has been smooth with only a few minor bumps. I credit our two-year preparation and training program for what has been a relatively calm week.
"There were a handful of instances where referrals were returned because ICD-9 codes were used for patients scheduled for appointments after the Oct. 1 implementation. These were quickly corrected and sent back to the referral facility with the correct ICD-10 codes.
"The real test will be on the coverage side. So far, we have not received insurance denials for ICD-10 coding challenges, but it is still too early to tell."
Bill Fox, Vice President of Healthcare and Life Sciences, MarkLogic: "The challenge is that all the existing app and platform solutions will need to similarly be up to speed to manage the new codes in concert. Many companies will run parallel systems: They will use tons of competing 'mapping' products, they will be doing tests and analytics to compare where the new coding is leading to overpayments (payers), underpayments (providers) and fraud, waste and abuse (regulators [like] CMS/OIG/DOJ). New generation technologies that can ingest the new codes will be critical in ICD-10 compliance success, as well as achieving financial, operational and quality care goals."
Suma Gaddam, Vice President and CIO, Care New England (Providence, R.I.): "We didn't see anything major or out of the blue happening. It's still too early to say whether we are in the safe zone or not from ICD-10. From a system standpoint, we were ready with the upgrades and updates in the ICD-10 platforms. We have clinical informatics staff supporting our physicians in using the new physician support tools to identify the proper ICD-10 codes that are available, like online radios that were created and shared with the physicians to help them identify the appropriate codes. We have a command center set up so physicians and other clinicians can call in and ask any questions that they may have. We haven't seen a huge volume but we have consistently seen 15 to 20 calls come in a day to the command center. We believe that because we had the clinical informatics staff on the floor supporting physicians, we did not see a huge volume of calls come in."
Suzi Grizancic, Principal, EY Americas Advisory Health Care sector: "Many hospitals and health systems appear to be having a relatively quiet transition. However, we are currently in the stage of the transition that is within their direct control — updating systems to recognize, pass and store the ICD-10 codes, managing process changes, training impacted employees and providers and focusing on documenting at an ICD-10 level of specificity. The next stage of transmitting information for authorization and payment and working between health systems, payers and pharmacies is only just beginning.
"Most of the current challenge occurred prior to the transition, especially dealing with the uncertainty caused by previous administrative and legislated delays of the implementation date for ICD-10. It took leadership and resources to re-focus energy and attention, to keep necessary new skills fresh, to test and re-test systems and processes and to re-mobilize teams to focus on ICD-10 over the last few years. Our next challenge will begin as we receive feedback on using ICD-10 in practice and it will come in the form of authorization, payment and denials data."
Bruce Hallowell, Managing Director, Navigant Healthcare: "One week post ICD-10 go-live and hospitals and physicians are just starting to code the first charts. The go-live started with a couple of system glitches that are being remediated. Now as we produce bills to payers and are experiencing the impact of the lack of documentation needed to code, the amount of time to code a record has increased. The coming weeks will be telling if we start to accumulate backlogs in coding. The next true measurement will be the effeteness of payer payments and the amount of claims denied and returned for additional information. We will not know the real impact until the middle of November."
Albert Oriol, CIO, Rady Children's Hospital (San Diego): "Truth be told, so far things are going even better than I anticipated. We have an awesome team led by Dorothy O'Hagan, our director of HIM, who ensured our readiness for the transition. [There are] lots of people involved from various disciplines and fantastic leadership and execution all around, from physician leaders driving clinical documentation improvement, to many months of dual coding to ensure coder proficiency, to focused revenue cycle education as well as testing and coordination with key payers, to excellent software vendor support, and a committed IT team. The many years of preparation seem to have paid off.
"The first couple of days we logged a total of three minor technical issues that were resolved same day and it has been radio silence since, a testament to the outstanding work by the team.
"We have submitted our first claim files containing ICD-10 codes and so far the files have been processed and accepted by clearinghouse and payers without any issues. Given the strong work on our CDI initiative we don't expect denials but nonetheless following [former President Ronald] Reagan's famous 'trust but verify' advice, we have beefed up our denials management monitoring processes and expect to start getting a feel for whether there is any impact on denials in about 10 days — once our payers go through the their claim review and payment processes.
"The uneventfulness of the event so far speaks to the tremendous preparation and hard work by thousands of professionals across the industry. We should be proud of them."
Renee Rasmussen, Vice President of Revenue Cycle, UnityPoint Health (West Des Moines, Iowa): "It's still very early on, but the IT cutover portion of the ICD-10 transition has gone well, with just a couple of small items that had to be addressed. UnityPoint Health dedicated a lot of resources to prepare our organization for ICD-10 systemwide. At this point, our investment is proving itself out. We have had an ICD-10 Program Team in place for more than a year, solely focused on preparing the entire organization for this change. Our coders were ready to go and have not reported any issues. We have been able to drop bills already, though volumes are still pretty low. Obviously, we have several milestones yet to achieve before we know if we have been effective, but so far the common comment is that things are quiet.
"We focused a great deal of energy on minimizing the impact of the transition process on our providers. For example, we setup small teams that proactively dealt with 97 percent of the open orders for services after Oct. 1 that didn't have the required ICD-10 terminology. So, our physicians only had about 3,000 of these orders hit their inboxes.
"Another area of focus was on education. We provided several CBT courses on ICD-10 documentation for our providers, and the vast majority of them completed that training ahead of Oct. 1. In addition, our clinical documentation specialists have spent a lot of time getting educated and preparing to be the contacts for taking specifics of ICD-10 documentation to the providers. We did some detailed work as a systems team identifying our specific provider documentation gaps and tailoring education to those gaps.
"We are anxiously waiting to confirm that the payers can process and pay our claims accurately and without a large increase in denials. We have teams prepared and on standby to react to any problems that are identified."
Diane Rivers, Coding Practice Director, CSI Healthcare IT: "The jury is still out on how the ICD-10 transition is going. Unlike an Epic go-live, the implementation of ICD-10 has too many levels and layers to make inferences after just one week. For example, documentation and training are ongoing, payers and clearinghouses need testing and reimbursements haven't happened yet. I expect that we'll have a better idea of the effects of ICD-10 by Dec. 1."
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