ICD-10: Solutions Guide – January/February 2016

At private-practice cloud technology solutions provider AdvancedMD, the trail to ICD-10 transition success was a long one. A cross-functional team of experts called the “ICD-10 Posse” waged a significant three-year campaign to provide tools and continuous education on the coding update process. As a result, 100 percent of AdvancedMD clients were ICD-10 compatible on Oct. 1, and the first ICD-10 payment was received only seven days after the transition.

Several weeks after the transition, clearing house rejections and carrier-level rejections have decreased from ICD-9 levels, and successful claims were at the highest level ever, signifying a positive financial impact for clients. Today, the pre-adjudication carrier rejection average for practices on AdvancedMD stands at 1.5 percent, far lower than the rate of 2.3 percent under ICD-9.

AdvancedMD credits its “full court press” on awareness and education for its clients’ success, and also its early and keen recognition that smaller physician practices, particularly those lacking extra staff, faced unique challenges with the ICD-10 conversion. Some clients initially slowed their claims billing on Oct. 1 in order to ensure a smooth transition. Claim submissions have since accelerated and recently broke the single-day claims record for AdvancedMD clients.

$25B and counting

A mere two-and-a-half weeks after the changeover to ICD-10, RelayHealth Financial reported that it had successfully processed more than $25 billion in claims using ICD-10 codes. The dollar volume represented more than 13 million institutional and physician claims processed using RelayHealth Financial’s revenue cycle management solutions, including RelayClearance Plus, RelayAssurance Plus, ConnectCenter, and EDI Services.

The revenue-cycle-management company says that it had its entire portfolio ready a full two years before the ICD-10 deadline.

“Claims are flowing successfully, and now the industry must be ready to tackle the next set of challenges: timely and correct reimbursement,” says Joshua Berman, ICD-10 Lead for RelayHealth Financial.

In order to help that process along, providers can monitor critical industry key performance indicators (KPIs) affected by ICD-10 on RelayHealth Financial’s real-time analytics dashboard at ICD10Central.com. Among these metrics, “days to final bill” is important to keep an eye on, says Berman, because it indicates whether providers are generating claims using ICD-10 as efficiently as they did using ICD-9. This number could drop, but should rebound once providers gain proficiency in using ICD-10. Berman says if the number dips and does not rebound, that means that urgent attention is required.

It’s great to be independent

Kareo, a provider of cloud-based solutions for independent medical practices, announced six weeks after the ICD-10 transition date that 99 percent of claims submitted in the first month of the ICD-10 coding transition were successful. Additionally, 87 percent of Kareo customers had already been paid for at least one submitted claim.

“In October, we saw close to 6.6 million electronic claims representing more than $735 million submitted through Kareo using the ICD-10 coding scheme,” says David Mitzenmacher, Vice President of Customer Success at Kareo. “Compared to results released by the Centers for Medicare and Medicaid Services (CMS) for October, practices using Kareo appear to have outperformed the larger healthcare industry in terms of the ICD-10 transition.”

Kareo also surveyed its customer base directly to gauge its experience with the transition. Based on customer responses, 57 percent of respondents considered the ICD-10 transition “easy” or “very easy.” Just 3 percent considered the transition “difficult” or “very difficult.” The remaining 40 percent considered it “moderate.”

One in 10 call it ‘failure’

Seventy-nine percent of the 298 attendees of a Nov. 9 KPMG ICD-10 webcast described their transition experience as successful. On the flip side, about 11 percent designated the transition a “failure.”

“While the transition to ICD-10 can be considered a thing of the past for some organizations, there is a subset of entities who considered their ICD-10 efforts as less than optimal,” says Todd Ellis, Managing Director, KPMG, an audit, tax, and advisory firm. Ellis gives the following reasons:

• Lack of physician readiness/training, as some providers thought the date would get pushed out again;
• Lack of proper system testing (how codes were actually mapped from ICD-9 to ICD-10);
• Relying on vendors for ICD-10 readiness and not addressing internal operational impacts (thinking a vendor platform would address all of the ICD-10 requirements);
• Impact of coders who were not prepared for the ICD-10 transition (lack of proper training); and
• Inability to hire HIM resources due to market demand.

Luckily, says Ellis, “There is still time for these entities to self-correct.”

ICD-10 Solutions

The present and future of coding

With the 3M Coding and Reimbursement System at its core, 3M 360 Encompass combines 3M’s clinical documentation improvement knowledge and software tools with proprietary natural language processing (NLP) capabilities. The system provides 3M expertise in the regulatory environment with powerful statistical methodologies to create a comprehensive NLP platform that uses both expert rules and statistics to deliver computer-assisted coding, clinical documentation improvement, and quality metrics. The results are improved reimbursement accuracy and reduced costs across your health system. 3M Health Information Systems

Improve clinical documentation on the fly

Dragon Medical Advisor is a next-gen computer-assisted physician documentation (CAPD) solution that automatically recognizes when incomplete or unspecific information is entered by physicians while they are documenting patient encounters and provides relevant advice on how to improve the quality of the note. This cloud-based solution processes physician notes using any input method (speech or keyboard), analyzes the structured and unstructured documentation within the notes, and automatically provides physicians with clinical documentation improvement (CDI) recommendations based on industry best practices and guidelines. Nuance Communications

ICD-10 success for the long run

The Health division of Wolters Kluwer has released additional ICD-10 remediation capabilities that enable payers and providers to build a solid foundation for long-term clinical, financial, and operational success in a post-ICD-10 environment. The enhancements are in the latest version of LEAP I-10, part of the Health Language family of services and solutions, and include the ability to import ICD-10 claims and analyze ICD-10 to ICD-9 DRG shifts, helping pinpoint areas of reimbursement risk. Users can also analyze new ICD-10 claims to identify payment variances and view detailed results by service line, specialty, facility, provider, and DRG; generate detailed reports to view the frequency of unspecified ICD-10 codes; convert ICD-9 codes within legacy reports with custom maps from ICD-10 to ICD-9 and vice versa; and stratify potential DRG shifts by financial impact to identify root causes. Wolters Kluwer

Fast, simple, and accurate documentation

Powered by ICD Sherpa, VitalWare’s patent-pending, proprietary Physician Documentation Engine, iDocuMint, bridges the gaps frequently found in clinical documentation today, guiding physicians to perform accurate documentation faster. Embedding ICD Sherpa into the physician workflow via PC or any mobile device effectively alleviates productivity concerns brought on by the new clinical documentation requirements. The company’s updated website includes a 90-second intro video showing physicians how simple and precise clinical documentation can be when using iDocuMint. Vitalware