ICD-10 has gone pretty smoothly so far, but savvy practices are planning their ICD-10 goals for 2016.
Fletcher Lance, vice president and national healthcare leader at consulting firm North Highland, pointed out that while some of what we were worried about in the lead-up to the ICD-10 transition did come true (a 25-30 percent drop in coder productivity, for example), some didn't (so far, only a roughly 2-4 percent increase in denials). "Everyone, understandably, has breathed a sigh of relief, but it's not time to take your hand off the wheel," said Lance. We can expect denials to continue to increase—even if gradually—as payers tighten up on specificity requirements. Lance also pointed out that there are still a lot of claims in the system that haven't made the loop yet.
Elizabeth Woodcock, president of Woodcock and Associates, an Atlanta-based physician practice consulting firm, agreed. "My concern is that right now payers are adjudicating pretty much everything that makes sense. When they start tightening up in the next 9-18 months, then we'll start to feel the squeeze." Practices shouldn't expect a "tsunami of denials," said Lance, but something more like "denial creep." Nonetheless it is something practices ignore at their peril. Woodcock expects that the tightening will first occur in the area of pre-authorizations and pre-certification requirements.
It's not just getting the codes right that practices need to be preparing for in 2016. "Once enough data is collected," said Tammie Olson of Management Resource Group, a firm offering financial management and support services for the healthcare community, "payment policies are likely to change. Conditions that were covered before may not be covered any longer." If you want ICD-10 to go at least as smoothly in 2016 as it as so far, here are a few steps you need to take:
* Make sure you have the financial cushion to cover a potential increase in denials—especially if your coding isn't totally up to par and you've been counting on leniency from payers.
* Track denials and work them in a timely manner.
* Continue to train coders — advanced classes and classes for specialties are available. Address any drop in coder productivity.
* Woodcock recommends designating one biller who sets aside a few hours each month to check for policy changes on the websites of every major payer. Changes will be posted on websites, and if you don't look for them, you won't know about them.
"Remember that ICD-10 may have been implemented Oct. 1, 2015, but the impact will continue," said Olson. "Just because things have been smooth so far doesn't mean that changes aren't going to come in the future." On the other hand, Lance sees plenty of reason to be optimistic. "Sometime in the next year or so, we'll start to see how we can use this data for better patient outcomes." And that's why we did all this, wasn't it?