Mounting an informed, intelligent transition to ICD-10

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 - Ben Strong, MD
Benjamin W. Strong, MD (ABR, ABIM), Chief Medical Officer, vRad

Countless healthcare providers of every type heaved a sigh of relief when CMS announced a one-year grace period following the Oct. 1, 2015, launch of ICD-10.

At a volume of 6 million studies per year, perhaps no one in radiology had more at stake than vRad when the agency flipped the switch on ICD-10’s soft launch on Oct. 1, 2015. Yet, just four months into the transition, the radiology services leader reports a successful transition at more than 2,100 client-provider sites.

The company has seen zero increases in the time it takes to post charges, no increase in denied claims due to medical necessity and a rise of zilch in days sales outstanding (DSOs), which is the time it takes to get reimbursed for completed work as a direct result of the transition to ICD-10.

More striking still, vRad has realized a 19% reduction in addenda requests coming in from coders seeking more information than they received in their radiology reports. The reduction cuts across vRad’s entire practice, including preliminary reports (for which ICD-10 compliance is far less relevant than it is for final reports).

How did they do it (particularly with limited control of processes at many client sites)?—and what can others learn from their labors? These questions and others are answered in a new vRad white paper detailing insights, best practices and pearls for providers wisely seeking to attain full ICD-10 code specificity in the months leading up to the hard deadline of Oct. 1, 2016.

Shannon M. Werb, Chief Operating & Information Officer

The practice’s CMO, Benjamin W. Strong, MD (ABR, ABIM), and COO/CIO, Shannon Werb, fleshed out the essence of the white paper— ICD-10: An Informed and Intelligent Transition—in a recent conversation with Medical Imaging Review.

Multidisciplinary mission

The pair recall how vRad started ramping up for ICD-10 in earnest in early 2014, when October of that year was still the expected launch date.

“October 1st felt like a looming brick wall given the complexity of providing imaging services for thousands of facilities—each with unique internal ordering processes and nomenclature,” Werb says. “We knew we had to lay a foundation for having a common, standard set of procedures so that when our clients ordered services from us, we knew exactly what those services were and how they related to services ordered by other clients.”

With input from medical leadership and numerous vRad departments (including account management, client services and billing compliance), Werb’s technology team set out to build a solution. They started creating a way to convert all clients to a standardized procedure set—and an expanded one in anticipation of ICD-10’s 70,000 possible codes—without interrupting the way the customers currently did business with vRad.

That meant creating a solution that would allow all 2,100-plus client facilities to order a study using their own unique internal naming conventions; one hospital’s “ultrasound gallbladder” is another hospital’s “ultrasound right upper quadrant” or “ultrasound liver.” Descriptions that facilitate the protocoling process are not standard across practices or facilities—even if they are all part of the same integrated delivery network with a common EMR.

“Creating a standard procedure set was a mapping and normalization exercise on steroids,” Werb explains. This was the beginning of Phase 1 of the project—or “Speaking the Same Language” as it is referred to in the white paper. It took the company almost a year and a half to complete.

Applying the 80/20 principle

Once the common-language foundation was built, Phase 2 was initiated. The white paper refers to this stage as “80/20 Relevant Reasons,” a bit of wordplay on the management-science principle that roughly 80% of the benefit comes from 20% of the work.

The idea was to “fully understand those customers and procedures that were most impactful for us in assuring success,” Werb explains. The company’s billing-compliance team performed a detailed assessment to shed light on commonly ordered imaging procedures. Their analyses enabled the team to focus on a subset of inputs, and still cover 99% of our billed volume. The team also looked hard at what clinical information was commonly coming in and what was too-often missing.

“How could we use this information to make it easy for our clients to provide all the information needed for ICD-10 compliance with a minimal amount of change to their existing internal workflows?” Werb asks. These