Why ICD-10 concerns me deeply

If you’re a practicing provider, chances are you still feel some anxiety about several issues related to the ICD-10 transition that are critical for maintaining the health of your practice. These probably include reimbursement, documentation workflows, potential audits, and claims denial.

As a family medicine provider, what I hope to see develop is the opportunity for providers to encourage payers to be more transparent about topics like the level of coding and documentation detail they’ll require so that physicians can reflect on them and ensure they have the appropriate internal systems built.

This will be a painful process and could potentially have a negative effect on clinical decision-making and patient care. That concerns me deeply.

Simply put, providers don’t want to create unnecessary systems of documentation that mean more clicks, burdensome workflows and highly detailed use of the new code set if they don’t absolutely need to. Increased transparency on the part of payers would go a long way toward easing the aforementioned concerns. Because right now, providers are waiting for payers to put their stakes in the ground and say, “These are what our rules are and this is what we’re going to be looking for when we review your clinical documentation.”

The opportunity for all of us is to create an atmosphere where providers and payers can have honest conversations that move ICD-10 transition planning out of the conjecture stage. Providers need to know exactly what to expect from their payers. If you think of it as a partnership, then providers don’t want to get too far ahead without knowing payers’ plans, and payers want to know what’s reasonable for them to expect of physician practices. The common enemy is an unhealthy percentage of denied claims, because in that situation, no one wins.

Looming over all of this is the Oct. 1 deadline that the Centers for Medicare & Medicaid Services (CMS) has established, a hard stance that now looks like a mistake. A phased rollout of ICD-10 might have prevented the current situation where much of the preparation is happening at once and has providers scrambling. Given the assumption that CMS will not push back the deadline, Oct. 1 could very well be a kind of big bang in healthcare.

On Oct. 2, many practices may have to cope with delayed claims reimbursement and a flood of questions about which ICD-10 code is the right one. There may be a mass denial of claims and in the following days, weeks, and months, a lot of confusion as providers seek reimbursement. These issues could extend beyond practices to healthcare organizations such as imaging centers and laboratories that might not be able to fully accept ICD-10, forcing providers to submit ICD-9s and ICD-10s at the same time.

If a provider practice hasn’t completed its testing, staff training and development of new documentation workflows by the October deadline, then they’re going to experience greatly impaired efficiency for a long time afterward. This will be a painful process and could potentially have a negative effect on clinical decision-making and patient care. That concerns me deeply when it comes to ICD-10 because many of these problems can be prevented by increased transparency by payers.

It’s unrealistic to say that all of these problems will become avoidable thanks to meetings and conversations at health IT events throughout 2014. Transparency by payers and honesty by providers can help ease the burdens that ICD-10 will place on the industry over the coming months and after the October 1st deadline. It’s not a stretch to say that both payers and providers can make more progress toward successful ICD-10 transition together than they can alone.

Brian Anderson is a family physician and senior manager, clinical content, athenahealth.  He can be reached on Twitter @bandersmdThis article originally appeared in athenahealth’s Health Care Leadership Forum.

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