The ICD-10 Hangover: Three Questions to Ask in the Aftermath of ICD-10

Are you breathing a sigh of relief now that the ICD-10 transition has come and gone? Readiness testing is a thing of the past. We are no longer faced with the hurry-up-and-wait deadline delays. We used our resources and updated codes and claims have been submitted. Now what?

We wait again.

What will be paid? What will be audited? What will be denied? Are we as ready as we thought we were?

While you wait...

Axea has four productive questions that you can be asking and some thoughts on how to approach the answers so that you are prepared for the next wave of impact.

1.     How can I turn uncertainty into productivity?

  • Determine the staffing needs post ICD-10 implementation.  Consider what positions are temporarily affected versus the positions requiring long-term change.
  • Manage billing staff time for increased legwork following up and tracking down responses from insurance companies.
  • Review reoccurring accounts that crossed the time span of 09.30.2015 to 10.01.2015.  If split claims were submitted before ICD-10 code requirements are there issues with a coding backlog or payment for these claims? Reduce errors by planning and staffing ahead to manage the increase in denial volume.

2.     How can I reduce the cash flow impact of denials or underpayments?

  • Create metrics to track progress and identify challenges proactively.
  • Track trends and issues with denials and underpayments so you are able to address and manage them more strategically.
  • Conduct a process review to identify areas of inefficiency.

3.     What additional education do we need to remain proactive?

  • Expand Physician documentation education.
  • Improve fluency in I-10 terminology.
  • Leverage an interactive, online learning tool for on-demand ‘brush up’ courses.

4.  Are our claims editor and other billing systems up to date?

  • Local coverage decisions may not be updated to include conditions previously reportable in ICD-9 cm.  Therefore, medical necessity coverage is affected.

What Else?

What additional questions are you facing as we move into this next phase? We hope you’ll share your outlook with us!