A recent survey of 200 hospital administrators, hospital health information professionals, and compliance employees conducted by Health Revenue Assurance Associates (HRAA), a provider of technology and revenue integrity solutions for health care organizations, found that exactly one year out from the transition, more hospitals are taking steps to prepare for the implementation of ICD-9 to ICD-10.
While the results showed that hospitals are focusing on employee training, the survey also revealed that they are leaving their organizations exposed to massive claims denials when the transition takes effect. This is because they do not understand what ICD-10 codes will be accepted by the payers as it relates to reimbursement maps and diagnosis-related group (DRG) groupings. Additionally, they are lacking denial strategies and financial models to help them avoid what could be a colossal claims backlog post-transition.
“The good news is that hospitals have jumpstarted their training and documentation improvement. The not-so-good news is that they are not putting enough resources against understanding how their payers will operate once the ICD-10 transition takes place,” says Andrea Clark, chairman and CEO of HRAA. “This change is a massive shift in the health care system and it is vital that hospitals are compliant and ready on October 1, 2014.”
The survey is a follow up to industry research conducted by HRAA in April 2013 which revealed more than one-half of hospitals were not complying with Centers for Medicare and Medicaid Services (CMS) suggestions and were falling behind the curve.
Of the hospitals surveyed:
• seventy-eight percent have begun ICD-10-CM training for coding staff, compared with last quarter’s 60%;
• sixty-four percent have begun ICD-10-PCS training for coding staff, compared with last quarter’s 45%;
• sixty-eight percent have begun document improvement education for medical staff, compared with last quarter’s 53%;
• seventy-six percent plan to dual code prior to October 1, 2014, compared with last quarter’s 69%.
“It is clear that ICD-10 is happening, and significantly more hospitals have begun programs since April,” says Clark. “This is vital as coder productivity is expected to decrease by more than 70% with the transition. The better trained a hospital’s staff is the more of a chance they can beat these estimates.”
While 71% of hospitals plan to submit ICD-10 coded claims to payers prior to October 1, 2014, they are not taking the initiative to understand how their payers are mapping their claims, which leaves them vulnerable to excessive denials and a slowdown in reimbursements.
Eighty-five percent stated that they don't know if their payers are planning to map claims utilizing CMS reimbursement maps to group the claims to DRGs. Internally, 42% stated that they plan to use CMS reimbursement maps to evaluate DRG groupings compared to those based on the ICD-10 grouper.
“The survey data show that while hospitals are focused on testing and preparing internally, they are not focused on mapping and the financial impact of the transition,” says Clark. “We are encouraging our clients not to make assumptions but to implement technology and analytics to do the financial modeling and denial strategies now, so that they won’t be playing a guessing game with their payers once the transition takes place.”
HRAA also developed a summary infographic.
Source: Health Revenue Assurance Associates