What Happens After ICD-10?

ICD-10 RedThere is an endless supply of articles and resources on ICD-10. Everything from training your staff, to making sure your vendors are ready, to assessing your practice readiness. But, with only 37 days remaining before transition, we wanted to shift the discussion to – What happens after ICD-10? A recent Deloitte Consulting blog addresses this question. In a post entitled “Preparing for life after ICD-10 Implementation” authors discuss some of the post-implementation challenges practices might face. Potential impacts include:

  • Operational disruptions: Implementation could trigger a decrease in coder productivity, backlogs in coding and billing, a fluctuation in performance metrics, and resource strain on clinical documentation programs.
  • Financial impact: Net revenue may decrease from cash flow interruptions and from increased denials and underpayments. Understanding the root cause of potential case mix and financial shifts will be critical.
  • Resource considerations: Change management processes, evolving training needs, employee retention, and resource reallocation may also present challenges.
  • Technological complexities and demands:Providers may experience data transmission issues causing a need for re-testing of critical functions and unscheduled vendor updates to ICD-10 software packages.

To help mitigate the impact, the blog recommends a carefully designed post-go-live strategy. Highlighted below, are a few of the strategies we believe are the most important for practices to address.

  • Monitor net revenue and cash trends:Model and focus on key financial metrics such as DRG shifts, CMI changes, claim rejections (i.e., edits), increases in time-to-pay by payers, payment variances (i.e., underpayments), increased denials, and impacts to A/R to track trends in reimbursement.
  • Assess documentation quality:Providers may still be wrestling with the new documentation specificity and granularity requirements, as well as using diagnostic terminology rather than clinical indicators. Formally reviewing documentation through a Clinical Documentation Excellence program is the most efficient and effective way to assess documentation quality, while also providing feedback loops to physicians through formal and informal educational channels.
  • Audit coding productivity and quality:Coders may still be trying to fully integrate new coding concepts into their work, especially with the procedure codes, which could impact both their productivity and their accuracy. Formally reviewing coder work through standardized key performance indicators around productivity and quality, and taking immediate corrective action by conducting additional training and stand-and-deliver educations sessions, as needed, could stem issues with productivity, quality, and accuracy.
  • Identify reporting and data integrity challenges:To achieve meaningful reporting and analysis using ICD coding (e.g., trend analysis, quality scoring, population management), data integrity across the transition is necessary. Modeling the state of the business and identifying how ICD-coded data is currently used in key reports and analyses that drive clinical, financial, and other decisions could reveal the options for handling the blended data during the conversion.
  • Assess your EHR template design:Updating the Electronic Health Record template to capture necessary information to support ICD-10 documentation requirements is an automated method that may positively impact quality and reimbursement.

To read the full blog post with a complete set of recommendations, click here.