3 Lessons Learned from the ICD-10 Switch

This month, folks everywhere are making plans to get healthy in 2016. But, unlike many resolutions made in January, ICD-10 is here to stay. We’re already more than halfway through the month, and while gym-goers might start to slack, HIPAA-covered providers don’t have the option to drop the weight of ICD-10. Even if using a new code set isn’t exactly like a new year’s resolution, it’s definitely a new habit. And with any new habit comes a learning curve, and, inevitably, a few lessons learned. So, here’s what we’ve learned since the switch:  

1. Preparation pays.

You’ve probably read this—and, hopefully, experienced it for yourself: ample preparation across the healthcare continuum made the ICD-10 transition a success—so far. This ExecutiveInsight article highlights one piece of the puzzle: “The Centers for Medicare and Medicaid Services offered extensive education and testing services, while private payers and clearinghouses provided a framework for success.” But, it wasn’t just CMS, payers, and clearinghouses that worked hard to get ready for the switch. Providers, billers, and coders put in a tremendous amount of effort, too. They audited their processes, learned how to use the new code set, found solutions to coding and transitional challenges, and stayed on top of communicating with their vendors and payers. Hopefully, the healthcare community as a whole will remember this lesson as we come upon more changes—and challenges—in the future.

2. Mistakes happen.

Prior to October 1, many providers were confused about when to submit ICD-10 codes—especially for those patients with cases spanning the transition date. And after the transition, confusion quickly gave way to mistakes. For example: “Some providers coded ICD-10 based on the calendar date thinking that they needed to use the new ICD-10 code set for claims submitted on or after October 1. ICD-10 requirements actually call for providers to code ICD-10 on claims with dates of service or discharge on or after October 1,” explains the same ExecutiveInsight article. Now that we’re several months into the transition, these mistakes are steadily waning. However, that doesn’t mean practices should coast until another coding change comes around. This Government Health IT article explains the importance of remaining vigilant in auditing processes: “Payers and providers will be well-served by instituting a program for ongoing analysis that specifically compares their assumptions about the effects of the transition against the real time activity they are observing as claims accumulate over the next 12 months.” In summation: providers need to pay close attention to detail if they want to avoid making simple—yet costly—mistakes.

3. Communication is key.

While we’re a long way from achieving total interoperability, making the switch to ICD-10 was a step in the right direction. That’s because interoperability relies heavily on communication, and ICD-10 allows providers a simpler, more accurate way to communicate detailed patient diagnoses to other parties. But, communication isn’t solely about providing accurate and complete diagnosis codes; providers also need to communicate with their payers and even their software vendors to prevent simple misunderstandings. Many practices did a good job of doing just that in the lead-up to the ICD-10 transition. As for those who didn’t? Many of them ended up making mistakes—and suffering delayed payments as a result. So, the lesson here is that communication pays—literally.

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Like a good—and sustainable—habit, ICD-10 has given providers plenty of positive takeaways. And for those practices that embrace the changes that lie ahead with a positive mindset and a willingness to put in some effort, the future looks bright for many new years to come. Have you learned any ICD-10 lessons? Fill out the form and tell us your story below.