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ICD-10 Systems Working as Promised, But Cause for Caution

“I don’t know a single person using this particular vendor’s system who wouldn’t happily throw darts at it for the disruption that has been caused."

- Two months after the ICD-10 regulation officially went into effect, evidence shows that the transition went well in strictly technical terms. However, beneath the surface, there’s reason for continued vigilance about the mandated changeover’s long-term impact.

First the good news: According to a report recently released by advisory firm KPMG, 80 percent of organizations moving to ICD-10 said that the crossover went smoothly. KPMG based its findings on a survey of 298 attendees of a Nov. 9 webcast titled “ICD-10: Just the Beginning.” Slightly more than half of survey respondents said they found “a few technical issues” during the transition, but overall it was considered successful. Only about 11 percent described the shift as a “failure to operate in an ICD-10 environment.”

Nonetheless, that small minority bears watching. Consider the remarks — based on personal experience — made by American Medical Association President Steven Stack, MD, during a Dec. 1 public meeting of a Health IT Policy Committee subgroup:

“The large enterprise vendor at one of [my] hospitals took two discrete workflows and eliminated all the quick picks so that now you have to manually type in every diagnosis you want to search for. It gives you an overly generic option [so] the tool that’s supposed to help you specify is so cumbersome that nobody uses it. We all just dictate or type in free-text diagnoses. Now essentially none of that is structured data. We used to have structured data diagnoses, and there was actually a code assigned, so it would suggest patient education sheets that were relevant to those discharge diagnoses. [The vendor] disabled all those crosswalks, so now we get a search box. If you come in with a sprained ankle and a broken arm and a laceration because you had an injury and there are three things we want to educate you on...we have to search all that manually.”

Stack cautioned that the vendor delivered a system that technically worked as promised through the ICD-10 crossover. Nonetheless, in practical terms, it has physicians fuming. “I don’t know a single person using this particular [vendor’s system] who wouldn’t happily throw darts at it for the disruption that has been caused — with no end in sight an no apparent announcement of corrective action being taken,” he said.

Catherine O’Leary, managing director for KPMG, acknowledged that providers would need to “dedicate more attention to the quality and specificity of clinical documentation to reduce rejected medical insurance claims.”

Indeed, 42 percent of KPMG's survey respondents cited ICD-10 challenges in the form of potentially rejected claims, documentation issues, reduced revenue from coding delays and IT fixes.

With ICD-10 now live, 46 percent of respondents said they were thinking of pursuing initiatives in clinical documentation improvement, revenue cycle optimization, and EHR/IT systems enhancement.

Craig Greenberg, advisory director at KPMG, added further perspective and reason to be wary: “Organizations are beginning to see dips in cash flow due to payers delaying the processing of ICD-10 claims while they ensure their ability to appropriately adjudicate these claims, while others are seeing an increase in claim denials over pre-ICD-10 levels."

 

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