Physician Practice

CMS touts ICD-10 success, but concerns linger regarding next October 1

Physician Practice Insider, March 8, 2016

Despite industry pushback and several delays, ICD-10 implementation has, against all odds, gone relatively smoothly for the vast majority of providers, leading CMS to tout its success in a February 24 blog post from Andy Slavitt, CMS’ acting administrator.

The agency should be commended for the mostly painless rollout of ICD-10 (putting aside the billions of dollars those delays likely cost the industry), which included establishing a communications center and naming an ombudsman to quickly deal with provider concerns.

That communications center upheld its self-imposed deadlines, responding to approximately 1,000 inquiries in October 2015 within three business days, according to Slavitt.

CMS also tracked data daily in order to locate issues in real time and head them off before they became too expansive, Slavitt wrote. According to this data, claims information from the fourth quarter of 2015 compares favorably to CMS’ historical baseline. The number of claims submitted daily during that period match the baseline at 4.6 million, and the number of claims rejected came to 1.9% of the total submitted, down from the historical 2%. The number of claims denied fell by the same amount to 9.9% of submissions from a historical baseline of 10%.

Collaboration with groups like the American Medical Association (AMA), American Hospital Association, and American Health Information Management Association (AHIMA) before implementation was another key to ICD-10’s success, according to Slavitt. The agency had to navigate sometimes-contentious relationships with these organizations to prepare providers, suppliers, and other stakeholders for the transition.

The AMA agreed to drop its increasingly nonsensical requests for an ICD-10 delay just months before implementation when it came to an accord with CMS to not reject Part-B physician fee schedule claims from the correct “family” of codes, even if they weren’t as specific as possible.

While this concession didn’t extend to hospital claims, it’s likely aided the number of successful claims submitted in the months after implementation. But that success could be fleeting, as discussed by Ken Bradley, vice president of strategic planning and regulatory compliance at Navicure, of Duluth, Georgia, in a February 17 blog post.

Physician practices that have not seen any denials due to code specificity could be in for a rude awakening in October when Medicare Administrative Contractors will be no longer accept the “family” of codes. Physician practices should be using this time wisely to continue training on ICD-10 and ironing out documentation issues.

The other wild card is that the long-standing ICD-9-CM and ICD-10 code freezes, which have meant no major updates since 2011. The freeze will finally end October 1. That means the industry could have hundreds of new codes, categories, or other changes to deal with at the same time it’s required to finally use complete codes to ensure payment.

That pent-up demand for new and more accurate codes, especially now that the industry has had practical experience with ICD-10, means we’ll probably see a lot of changes. As far back as 2014, Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, vice president of strategic development for AAPC in Salt Lake City, said at least 500 updates were ready to be made to ICD-10.

Discussions on which new diagnosis and procedure codes to consider will take place in March when the ICD-10 Coordination and Maintenance Committee meets. Providers can call in or watch the meeting via webcast for a preview of potential changes.

Providers can help mitigate upcoming challenges and continue the success of the initial implementation by continuing to train, working with physicians on documentation, and following the latest developments out of CMS.

In an effort to address these concerns, CMS has released a Next Steps Toolkit to help providers track and improve upon a facility’s ICD-10 progress. The toolkit, which is available for download through the CMS website, features five pages of information which includes resources on how to:

  • Assess ICD-10 progress using key performance indicators to identify potential productivity or cash flow issues
  • Address opportunities for improvement
  • Maintain progress and keep up-to-date on ICD-10

The toolkit includes educational sources for clinicians and coders to use when troubleshooting various topics such as software issues or code selection problems. CMS plans to release a companion infographic with simple steps from the Next Steps Toolkit in coming weeks.

This article was adapted from articles originally published in the Revenue Cycle Daily Advisor.

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