The Success* of ICD-10 – A Snapshot from the “ICD-10 Six Months In” Presentation at the April 2016 Health Care Compliance Conference

Six months after the ICD-10 transition, the Centers for Medicare & Medicaid Services (CMS) issued a public statement detailing metrics1 for Medicare fee-for-service payments throughout the first few weeks of the new standard. 

The upshot: The ICD-10 transition was deemed a success* 

That asterisk is because a few weeks actually can’t tell us much. Even with the CMS Claims Dashboards showing fewer than 2% in claims being denied, there are still delays. Medicare claims take several days to be processed and, by law, Medicare must wait two weeks before issuing a payment. Medicaid claims can take up to 30 days to be submitted and processed. 

The reality is that we can’t know how well organizations are doing with the new standard until we get through a least a full fiscal quarter or more of claims payment activity in 2016. For some, an enormous increase in appeals or a crippled cash flow might still occur. Worse yet, the level of medical coding inconsistency among providers may impair the risk adjustment models in place to support a variety of population based payment contracts. Inevitably, there will be at least a few organizations whose leaders wake up one day and realize they made bets on bad assumptions related to predicted shifts in coding behavior. 

So, is there a way to make sure you’re not blindsided by problems you didn’t expect? I think so:

1. Track denials and payments as they come in.

Double check that denials and the cause of them are correct. Post ICD-10 implementation, they might not be. Look for trends that might indicate a pattern – either of documentation errors or payer errors that will need remediation. 

2. Make sure that all clinical documentation includes the newly required higher level of specificity.

For example: if the provider indicates that a patient has a pressure ulcer, documentation must include: anatomic location, laterality (right vs. left), stage of ulcer and whether gangrene is present. Yes, all must be included. 

3. Identify, report and address all ICD-10 issues.

And remember that one person can’t do it alone. Collaborate with your own team, your providers, and (where relevant) your third party support partners. And be aggressive with training as you identify issues and plan ahead to ensure that corrections are effective. 

4. Keep calling payers until they answer questions.

Do not let any denial go because calling to question, validate and/or resubmit is too much work. 

Bottom line: Clear, accurate, thorough clinical documentation matters more than ever. And ongoing education – including problem identification and remediation – is the new normal. Stay on top of both, and when you look at your own ICD-10 transition results, you can remove that asterisk next to “success.” 

Learn more about how web2pro can help you uncover denials and improve clinical documentation.


Merit-based Incentive Payment System (MIPS) Final Rule

Bess Ann

About the author

Bess Ann Bredemeyer is vice president, Compliance, at web2pro Business Performance Services. She has more than 25 years experience in optimizing revenue cycle operations for healthcare providers across the United States.