Revenue Cycle Management Blog | GroupOne Health Source

Post ICD-10: What to Expect After October 1st

Written by Keith Lage | September 30, 2015

Tomorrow ICD-10 will replace the current classification system, ICD-9. Whether you're ready or not, ICD-9 codes will no longer be accepted on claims. Claims with ICD-9 codes after October 1 will be denied without payment. While surveys indicating readiness for the ICD-10 transition vary, one thing is for sure: ICD-10 will dramatically impact medical billing and cash flow. 


What Can Medical Practices Expect Following the ICD-10 Transition?

2014 survey by AHIMA and the eHealth Initiative found that over one-third of providers think their medical billing will take a hit from the ICD-10 transition. Claims error rates are expected to increase significantly during the transition, reaching levels of 6% to 10%, compared to the typical 3% error rate with ICD-9. 

Because the new coding system is more complex and because coding specialists will have to climb the ICD-10 learning curve, providers can expect their medical billing cycle to slow down. Days spent in accounts receivable are expected to increase as well. Therefore it's critical that providers prepare their medical billing teams for the switch and be ready to investigate high volumes of claims denials to get to the root of them.

 

Claim denials

Under ICD-10, claims denials will be less likely to be addressable by non-clinical medical billing staff. Rather, under ICD-10, denials are more likely to be about medical documentation and medical necessity and will need to be addressed by physicians or nurses. ICD-10 will require coding specialists to understand more specific aspects of clinical procedures compared to what they were required to know under ICD-9. A 2012 study found that on average coders took 18 minutes longer to code a record under ICD-10 than under ICD-9.

 

Physician documentation

Under ICD-10, physicians will have a bigger role to play in denials management. Not only must medical billing staff understand the depth and types of information they will have to provide for claims to be processed, but physicians will have to be ready to add their clinical input when denials occur. Practices with good denial management procedures under ICD-9 may find those procedures inadequate after the ICD-10 transition. 

At the same time, practices will need to control the daily documentation burden on physicians so they can devote sufficient time to treating patients. Some facilities do this by deploying medical intelligence systems that create templates or criteria to guide doctors through the documentation necessary to support procedures or diagnosis codes under ICD-10. 


Steps to Help Ensure Readiness for ICD-10

A 2013 Healthcare Financial Management Association document on preparing for ICD-10 presents a checklist that facilities can use to promote readiness for the transition. Steps include:

  • Understanding existing trends in denials under ICD-9
  • Tracking progress in denial management technology adoption
  • Making baseline measurements of efficiency and accuracy of coding and clinical documentation
  • Identifying high dollar or high frequency procedures most at risk for claims denial and addressing those risks
  • Identifying and addressing problems with the denial resolution process
  • Investigating technology for coping with denial management
  • Assessing financial resources available to work as a backstop should claims denials spike after the ICD-10 transition


Conclusion

Medical billing will require more information and accuracy under ICD-10. However, the transition will ultimately enable a new generation of healthcare analytics that should lead to better care and greater delivery efficiency. Frontline medical billing staff, physicians, nurses, and healthcare executives must take steps to prepare for the changeover to minimize problems.

GroupOne Health Source offers full-service medical billing, transcription, and technology for healthcare providers throughout the US. With expertise in all aspects of the medical billing cycle, GroupOne Health Source is 100% ICD-10 ready and can help your practice avoid cash flow interruptions with ICD-10. Contact us today to learn how we can help your practice succeed post ICD-10.