So, You Switched to ICD-10. Now What?

On September 30, 2015, healthcare providers all over the US were partying like it was 1999, but October 1 came and went—and for most folks, nearly nothing bad happened. We’re still in the early stages of the switch, so we can’t say for sure that it’s smooth sailing ahead, but if you felt like the transition to ICD-10 was more “calm waters” than “catastrophe,” you’re certainly not alone. PR Newswire announced this week that 79% of 298 organizations surveyed on November 9, 2015, by the tax, audit, and advisory firm KPMG LLP said the transition “has proceeded smoothly.” Here’s a more detailed breakdown of those responses:

  • 28% indicated they experienced a completely smooth transition.
  • 51% indicated they experienced a few technical issues, but were successful overall.

However, it wasn’t all clean claims and speedy payments, as 11% of respondents indicated their ICD-10 transition was a total failure.

Growing Pains

While it’s certainly a far cry from the doom and gloom many providers predicted, if you’re one of the 11%, you’re probably feeling a bit doomy and gloomy, thanks to some—or all—of the transition’s biggest challenges, including:

  • Rejected medical claims
  • Clinical documentation
  • Physician education
  • Reduced revenue from coding delays
  • Information technology fixes

But the transition to ICD-10 doesn’t have to be a death knell for your practice. After all, other clinics are hitting it out of the park—and you can, too. So, now what?

Moving Forward

According to this recent Managed Healthcare Executive article, the keys to success moving forward are:

  • tracking your key financial and operational performance indicators;
  • making timely, decisive actions;
  • keeping a pulse on the morale of your most impacted employees;
  • showing leadership and support; and
  • focusing on communication.

Furthermore, “providers will need to dedicate more attention to the quality and specificity of clinical documentation to reduce rejected medical insurance claims.” But that doesn’t tell you anything you don’t already know, right? There are several ways to handle this post-switch period, so what’s your first priority? Well, like 46% of survey respondents, you can tackle auditing your internal processes and systems, including:

  • Clinical documentation
  • Revenue cycle management
  • IT systems
  • Electronic health record system

That last system, in particular, plays a huge role in your ICD-10 transition—for better or for worse. As one provider reminds us in this Medical Economics article, “You learned ICD-9; you can learn 10 and with technology it is easier.” Another provider echoed that sentiment, advising healthcare professionals that “there are better tools available for dealing with these codes” and telling them to “ask your [EMR] vendor whether they can provide them.” My advice? If your vendor can’t offer what you need to be successful, find one that can.

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Okay, so that’s a good place to start, but keep in mind there’s a lot more to the ICD-10 transition than just optimizing your processes: there’s much to learn—and unlearn—and that’s no simple task. It’ll take time and effort, but your practice can make a full recovery from the transition to ICD-10. You’ll be back on your feet—and in the black—faster than you can say ICD-11. (Too soon?)