Radiographs of the ankle, hip and knee getting coded as mammograms; a popular code-assist product failing right out of the gate and remaining troublesome months later; small billing companies shuttering their offices, leaving physician practices without any billing services at all. These are some of the scenarios reported in the wake of the Oct. 1, 2015, launch of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).
Ann Barnes, president of MedData, one of the largest revenue cycle management (RCM) firms in the U.S., says such troubles were inevitable heading into the ICD-10 era, but they are fixable going forward. If high-performing coders are indispensible to the job, so is equipping them with up-to-the-task technology.
Well-trained coders, a sharp technology platform and a laser focus on clients and their patients all served MedData well through the transition, according to Barnes. She recently took questions on ICD-10 from imagingBiz. Key excerpts follow.
Q. What have you observed since the October 1 launch, both among your clients and the industry at large?
Barnes: MedData was a little unique in that we were excited about the transition to ICD-10, and, in fact, were disappointed each time it got postponed. The reason: we spent the last three years getting ready by building the technology crosswalks and guided coding platform, by analyzing each of our clients to see where documentation would be deficient as we moved into ICD-10, and by starting physician education early.
All this investment in technology, training, and time resulted in a very stable transition both for our organization and our clients. I think the industry has seen a 40% average dip in coding productivity, while we are running at just about a 1% decrease post-transition. Given the increase in coding complexity, this performance means that all of our work has paid off.
As we anticipated, physician documentation did in fact turn out to be the biggest challenge for the transition. ICD-10 requires a much higher level of specificity for reason for exam than clinicians and technologists are accustomed. Cumbersome implementations of electronic medical record systems were already causing a dip in documentation and adding to the overall turmoil in the coding marketplace. For many RCM companies, it was somewhat of a perfect storm.
On additional observation: Organizations without the mission—and the platform—to deliver a patient-centric approach to collections are experiencing even more frustration with the ICD-10 transition. First, they’re falling down on coding accuracy for reimbursements, and second, they aren’t able to optimize collections for the services for which they are billing. It’s a double whammy that is definitely impacting their short-term bottom line and their longer term patient relationships.
Q. Explain how MedData is leveraging a patient-centric services approach as part of its ICD-10 transition?
Barnes: When we started down the patient service path prior to our ICD-10 implementation, hospitals were not yet fully seeing patient satisfaction post-discharge as a key piece of the puzzle for long-term growth. They very much do now, especially post transition when RCM is under the microscope by their executive teams.
It doesn’t matter whether one of their patients went through radiology or anesthesiology or cardiology or primary care or emergency. All patients, once they get into the collection cycle, are going to behave the same way. They are going to behave by balance size. So, if you don’t have insight into how much a patient owes—in total—you aren’t armed with the information you need to maximize collections.
For example, if you have a $50 co-pay today, but also owe an additional $1,000 around the network, we know that you are going to behave like you owe $1,000; you’re not going to behave like you only owe $50. Our platform enables hospitals and groups that don't have the technology to see the patient across that kind of landscape. By combining all relevant data in a platform specifically designed for RCM, we help our clients see the true status—and value—of a patient so that they can use the most effective RCM tools. Again, critically important in the transition to ICD-10 when it’s not enough to simply code differently. You’ve got to collect differently as well.
Q. How does technology facilitate this process?
Barnes: Because MedData has a dedicated patient technology platform,