Hospitals May Not Be Ready for ICD-10

The health care industry is preparing to shift coding from ICD-9 to the far more robust and complex ICD-10 in under a year. Providers are ramping up their efforts, yet still may not be ready. A new survey from Health Revenue Assurance Holdings concludes:

[Hospitals] 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,” said Andrea Clark, chairman and chief executive officer of HRAA.

Providers are heads-down in revamping their systems. Many have assumed health plans will be completely ready to handle the new codes, but in my view that’s overly optimistic. One step providers can take is to pre-emptively increase the thoroughness of their clinical documentation in order to increase the chances of their claims making it through without getting kicked out for additional scrutiny.