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Late To ICD-10 Preparedness? Get Started in 5 Minutes

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Are you preparing for ICD-10? If you’re like many entities in the healthcare industry, you likely haven’t considered the impact that the new coding system will have on you and your facility. If you haven’t, we’re going to get you up to speed, and offer you some powerful solutions that will have you readily prepared to face the challenges that the October 15th deadline will bring with it.

As much benefit as version 10 of the disease classification system will bring, the level of complexity it requires to do so is where the problems come in. For example, ICD-10:

• Features seven digit codes. Version 9 had only five.
• Contains 68,000 codes, while ICD-9 contained 13,000.
• Has been changed to feature modernized, standardized language.
• Uses codes that reflect both diagnoses and symptoms (meaning that in a few cases, fewer codes will be needed to describe the same condition).

All these changes mean necessary training for your coders and billers, a slowed revenue cycle process, and a resulting AR environment that is more complex and difficult to navigate profitably. Answering all those problems is what we want to talk to you about next.

Impact On Radiology:
While it is possible that the October 1st, 2015 implementation date could be pushed out, it isn’t likely.

Representatives from all over the healthcare industry spoke with the subcommittee of the House Energy and Commerce Committee, in February, recommending that the deadline should not be delayed. This means that even entities that have delayed or paused implementation preparations need to start seriously considering solutions to their impending coding problems.

For radiology, this means that the interactions between referring physicians and radiologists will be fundamentally changed. Because of the increase in complexity of 10, the amount of information required from physicians will increase dramatically. Imaging facilities looking to schedule exams will need much more detailed patient histories to precertify, bill, and dictate procedures.

Radiologists themselves will also be impacted, with their documentation requiring much more specificity and detail around inpatient procedures. (Review our Gap Analysis Proposition for insight into this problem.) This will create the added issue of potentially drastic differences between coding patients who are inpatient versus outpatient, since ICD-10-PCS applies only to inpatient procedures.

Radiologists themselves will also be impacted, with their documentation requiring much more specificity and detail around inpatient procedures. (Review our Gap Analysis Proposition for insight into this problem.)  This will create the added issue of potentially drastic differences between coding patients who are inpatient versus outpatient, since ICD-10-PCS applies only to inpatient procedures.

According to Radiology Today, radiology providers will need to find ways to keep referring providers from slowing down work through their own lack of preparedness around new codes and reporting requirements. On the imaging facility side, managers will need to work with referring physicians to help them navigate the transition to ICD-10, as this is the foundation of radiology billing needs.

Meeting these needs will be incredibly difficult, and almost impossible without the proper ICD-10 solution.

Impact On Coding And Billing:
ICD-10’s impact will be felt by radiology most acutely around coding and billing.

The new coding system also includes three sections devoted solely to radiology, and the codes will have to be matched correctly with CPT coding for all procedures. Radiology Today provides an illustrative example involving chicken coops,

“ Just suppose a patient fell in a chicken coop, suffered significant head trauma, and was admitted to the hospital. The patient was then sent for an MRI of the brain. Under the current system, the billing department would use CPT code 70551 for an MRI of the brain without contrast. The matching ICD-10-PCS code is B030ZZZ, Magnetic Resonance Imaging (MRI) of Brain. It would also be necessary to match up codes for the diagnosis in the ICD-10-CM code list, including S06.0X1A, Concussion with loss of consciousness of 30 minutes or less, initial encounter, and Y92.72, Chicken coop as the place of occurrence of the external cause.” (You can find more useful examples in this whitepaper)

Mistakes around any of the coding, billing, and/or documentation process will mean delayed reimbursement for your facility, and most likely lost revenue.

Revenue Cycle Dead In The Water?
As you can see from the examples above, there are multiple areas where the revenue cycle process could be stalled, or even completely halted without proper preparation.

While ICD-10 will obviously have an impact on the billing and coding process, it can be easy to forget the fact that the new coding system will be felt throughout the entire revenue cycle. In other words, be ready to feel the reality of ICD-10 in your cash collections and reimbursement.

Many experts are predicting an increase in coding-related denials after the implementation, most specifically because of the lack of alignment of ICD-10 codes with existing codes from version 9.  You will likely find your denials being rooted in issues not only with coding, but in preauthorization and precertification processes, along with the mistaken practice of straight translation from ICD-9 (Learn more about avoiding straight translation issues with our dual coding solutions that feature a radiology-focused, senior coding consultant, certified in both code set versions here).

The American Health Informatics Management Association also stresses the importance of ICD-10 around revenue analytics stating, “…accurate ICD-10 code assignment will not only be important for reimbursement but also for revenue analytics. Rate modeling and forecasting as well as internal and external reporting have become a routine part of revenue cycle operations. Assumptions and external metrics are at risk for inaccuracies if the data upon which they are predicated is flawed.”

Finding Solutions:

You can reasonably expect a drop in organizational productivity for six months after the ICD-10 implementation.  Expect to see this in your coding, billing, and accounts receivable resources. The best way to address, and even prevent this lag in productivity is through a stable and consistent ICD-10 transition solution, and that is what we at Infinx are here to bring you.

We will walk you through our proprietary process of assessment, training, practice coding, documentation gap analytics, and launch in a way that address your needs by specialty, tackles business intelligence issues, handles payor problems, and much more.

We encourage you to invest just three minutes in watching this video to get started, and to then contact us so that we can begin addressing all your preparation needs for the upcoming ICD-10 implementation.

InfinxLate To ICD-10 Preparedness? Get Started in 5 Minutes

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