Healthcare ICD-10 Conversion: One Expert's Tips - InformationWeek

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11/14/2011
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Healthcare ICD-10 Conversion: One Expert's Tips

As the ICD-10 conversion deadline approaches, consider this advice from Booz Allen Hamilton's Beth Mahan to make the best of a painful transition.

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ICD-10 implementation promises to be complex, costly, and burdensome, so healthcare CIOs and IT managers can use all the help they can get. InformationWeek Healthcare recently interviewed Beth Mahan, principal at Booz Allen Hamilton's healthcare division to help shed some light on the issues leading up to the October 2013 conversion deadline.

When asked what providers should keep in mind when discussing ICD-10 readiness with high-volume payers and external vendors, Mahan pointed out that ICD-10 will provide new specificity and greater granularity in diagnosis and procedure determination, but the question remains: how will facilities incorporate these into payer contracts?

Other questions that need to be addressed, according to Mahan: Are you talking to top payers to determine if they're ready to process your claims in both ICD-9 and ICD-10? "If exceptions are provided for payers and vendors that cause suspended claims, will this lead to increased delays and claim denials? If so, will organizations have the staff to conduct necessary, case-by-case reviews? Will your payers require changes to the preauthorization process requiring more detailed procedure codes [and] potentially creating delays?"

[That healthcare organizations have less than two years until the ICD-10 compliance deadline is shaping up to be a big problem. Learn about ICD-10 Madness: Most Providers Aren't Ready.]

On the subject of financial modeling as providers move to ICD-10, Mahan commented that "diagnosis-related group (DRG) shifts may occur with ICD-10 and these shifts may impact reimbursement. Comparative analysis and mappings can improve clinical documentation capture, assess where predominant diagnoses and procedure codes map to multiple ICD-10 codes, and allow impact analysis to be conducted."

She believes that a financial modeling tool will let providers use actual historical data from their systems, allowing them to analyze and simulate the financial impact from ICD-9CM to ICD-10CM/PCS diagnosis and procedure code sets. "Going forward, changes to payer or case mix and DRG shifts will be revealed in the data, and based on the results, providers can discuss reimbursement schedules and or policy changes with their payers."

Mahan also had some insights on developing a strategy for coding, billing, and claim backlogs to improve cash flow.

"Providers should start planning and working now to reduce current coding backlogs. In addition, providers should work to clear aged accounts receivable and open denials ... to enable staff resources to focus on supporting ICD-10 claims and monitoring for trends. This will help reduce the need for external or additional resources," she said.

"Next, determine if you need both ICD-9 and ICD-10 teams aligned for areas where dual use of the codesets may still occur, such as worker's compensation or auto liability claims not covered under HIPAA or ICD-10 mandate at this time. Finally, providers need to assess their internal performance metrics or dashboard to add ICD-10 indicators for monitoring and trends data around cost effectiveness to collect. This should include reports to assess productivity shifts, days not billed, claims denied and not overturned, payer processing time, and other key performance metrics," Mahan advised.

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