Month: April 2015

ICD-10 Project Update: April

Jason Gottlieb

174 days to go – As we continue our MARCH towards the ICD-10 implementation date of October 1, 2015, this past month’s characterizing idiom is particularly resonating. The legislative landscape certainly came in like a lion with questions, concerns, and debate about the expiration of the 17th consecutive fix to the sustainable growth rate formula (SGR) for physician payments. Would there be a permanent fix? Will another ICD-10 delay be included in the legislation defining that fix? Ughhh… the suspense was killing us all! The frustration, mounting! And, for all the structure of the legislative process, all the hearings, and all the social media pundits waxing poetic about the possibilities, it was the proverbial “hug it out” sessions between the two leaders of the House and Senate respectively that composed a permanent fix to the SGR. On March 31, the house passed the recommended legislation by an “oh so close” vote of 392 to 37. And out like lamb March went. Quietly, and without as much as a peep, much less a roar of another ICD-10 delay.

As I compose this from the living room couch, I am comforted that the sneezing fit my wife endures (…and interrupts The Blacklist) is less than 6 months away from being able to be coded as R06.7 (sneezing) instead of 784.99 (Head & neck symptoms not elsewhere classified). Yep, there’s a code for that… in ICD-10.

A list of NYP’s most recent and cumulative accomplishments continues to move the organization closer to realizing these benefits and much more.

  • Operationalize dual coding.NYP continues to expand its dual coding efforts eclipsing 6000 inpatient and outpatient claims collectively. Dual coding interface development for additional outpatient services including the ambulatory care network is expected to commence this month.
  • Complete end-to-end claims testing with payers. A long and arduous milestone has been achieved by our influential Managed Care team securing a testing commitment with our largest contracted payer, Empire Blue Cross Blue Shield.
  • Supporting Hospital operations with an ICD-10 ready technology and data infrastructure. The project teams continue to leave no stone unturned, searching for every aspect of functionality leveraging diagnosis and procedure code data. 25 major and proprietary claims processing and editing routines in the Eagle Billing system have been converted to ICD-10 code criteria.
  • Creating an ICD-10 informed and insulated organization. The ICD-10 message continues to be spread across all levels of the NYP organizational hierarchy. The project’s website, ICD-10 AnTENna has surpassed 2000 hits and the content for an online organizational awareness module has been defined and will initiate development in the next 30 days.

Other activities will continue to progress and expand under the assumption that no further delays shall occur. For a complete overview of the project status, click here to view the Project Scorecard.

Should you have questions about what you can be doing to get your department ready for ICD-10 or would like to request an in person presentation from the ICD-10 project team, please e-mail ICD10Help@nyp.org.

 

WEDI Survey Suggests Mixed Industry ICD-10 Readiness; NYP remains ahead of the curve

Jason Gottlieb

The Workgroup for Electronic Data Interchange (WEDI) has released the results of its latest ICD-10 readiness survey released in February 2015. The findings suggest that while there has been incremental progress along some activities, the uncertainty created by past delays is a catalyst for stagnation that could put entities at risk come October 1, 2015. Based on responses from 1174 participants including 796 providers, 173 vendors, and 203 health plans, an increase of more than 100% from the August 2014 survey, WEDI summarized its findings in its March 31, 2015 letter to Department of Health & Human Services Secretary Sylvia Mathews Burwell.

  • Compliance date uncertainty: Uncertainty around further delays was listed as a primary obstacle to implementation, appearing on more than 50 percent of all responses for vendors, health plans and providers.
  • Health plan testing: More than 50 percent of health plans have begun external testing, and of these, a few have completed testing. This is a slight improvement from the prior survey.
  • Vendor product availability: About 60 percent indicated their vendor products were available or they had started customer testing. This is a slight decrease from about two-thirds in the August 2014 survey. However, the number that responded ‘unknown’ decreased from one eighth to just a handful.
  • Provider testing: Only 25 percent of provider respondents had begun external testing and only a few others had completed this step. This is actually a decrease from the about 35 percent of provider respondents that had begun external testing in the August 2014 survey.

Independent of the state of industry readiness, NYP continues to be ahead of the curve in both its diligence, remediation, and testing activities as it moves toward an internal ICD-10 implementation date of July 1, 2015.

To view WEDI press release and the letter to Secretary Burwell, click here.

 

 

 

The Benefits of ICD-10: Improved Claims Processing

Jason Gottlieb

Much of the delay in healthcare claims processing comes from insurance companies’ requests for supporting medical documentation.  This, in and of itself, a byproduct of the relative dearth of information the outdated ICD-9 coding system provides on the submitted claim.  The assembly and submission of patient records and the subsequent time for the insurance company to review those records and render a determination can add 60 days or more of additional processing time and untold costs for both sides of the claims processing equation.

The promise of ICD-10 is that more specific descriptions of patient conditions and the services used to treat those conditions will enable insurance companies to render payment determinations without the need to request additional documentation.  In a recent interview with RevCycle Intelligence, Pam Jodock, Senior Director of Health Business Solutions for the Health Information & Management Systems Society (HIMSS) articulated how the increased granularity and specificity of ICD-10 coding can lead to a more efficient claims processing cycle with insurance carriers.

“There should be fewer claims pended for requests for medical records because the ICD-10 code will provide the information not included in ICD-9 codes today,” Jodock says. “Hopefully over the course of time, we’ll see a streamlining of claims payment and providers will see a reduction in the number of claims that get pended or rejected at first pass.”

In addition, providing details in the form of coding related to social, psychological, economical, and clinical circumstance allow providers to better defend the severity of their respective patient populations.  Jodock states, “Providers can only control a small portion of outcome with their patients. There are other things — comorbidities, lifestyle choices and adherence to medication protocol — that will impact outcome,” claims Jodock. “The more of that type of information that providers are able to capture, the better able they’ll be able to account for those factors when negotiating appropriate reimbursement levels.”

With 6 months to go before October 1, documentation and coding proficiency in ICD-10 is pre-requisite to achieving revenue cycle and claim processing efficiencies.  Continue to check in with ICD-10 AnTENna for tools and resources to ready your department for October 1, 2015.