May 21, 2013

ICD-10: The Countdown Continues: What’s it Going to Take to Achieve Physician Compliance?

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With nearly 500 days and counting until the ICD-10 implementation date of Oct. 1, 2014, it is apparent after attending the American Health Information Management Association (AHIMA) ICD-10/CAC Summit that the majority of the healthcare industry is continuing to move at a slow pace.

This was echoed in numerous polls performed by various vendors during the last six months as well as during the April 23 broadcast of Talk-Ten-Tuesday (titled the “State of the Union – Live from the AHIMA ICD-10/CAC Summit.”) Everyone seems to be talking ICD-10, but the polls indicate that about 80 percent of the industry is still in the assessment or planning phase of implementation. Here is a summary of the latest poll from the April 23 broadcast:

What percent of the healthcare industry do you think will really be ready for ICD-10 on Oct. 1, 2014?

 

Response Ratio

A. 25% or less

11%

B. 26-50%

23%

C. 51-75%

42%

D. 76-99%

23%

E. 100% Everyone will be ready!

1%

Copyright © 2013 | ICD10monitor.com, a division of Panacea Healthcare Solutions, Inc.

There are many reasons for this slow pace, or what I refer to as  simple procrastination: the one-year delay in the implementation date, a lack or shifting of resources, altering focus to other regulatory changes tied to penalties and money, etc. But the biggest reason is lack of cooperation from physicians.  Physicians do have other pressing regulatory issues at hand with meaningful use, adoption of the electronic health record, payfor-performance, and other quality initiatives, but ICD-10 can no longer take a back seat! ICD-10 may not be tied to penalties just yet, but not implementing it at 100 percent will cause an increase in denials and claim rejections.

In a February 2013 whitepaper titled “Readying Your Denials Management Strategy for ICD-10,” published by the Healthcare Financial Management Association, it was indicated that “the Centers for Medicare & Medicaid Services (CMS) estimates that in the early stages of implementation, denial rates will rise by 100 to 200 percent, and that days in A/R will grow by 20 to 40 percent.”

Granted, there are factors other than lack of cooperation from physicians that lead to increases in denial rates, such as information system issues, coder productivity, and unfamiliarity with adjusted medical review policies, to name a few.  Clinicians, physicians included, in general are more inclined to focus on providing great patient care and not as much on their documentation. With the current shortages of clinicians in heathcare, patient care must be a priority, but to have successful ICD-10 implementation, documentation must be a matter of paramount importance: it’s a catch-22!

What we have seen in the industry is that more than 50 percent of the current ICD-9 documentation reviewed is deficient and therefore will not “cut it” in ICD-10. This statement is supported due to the specificity required by ICD-10 coding. Yet this is a great problem to have, especially if you are a clinician, and here’s why: an increase in coding specificity requires clear and concise documentation, but better documentation leads to better data and more opportunities to study the data to improve business and clinical operations, rendering improved patient care, quality outcomes, and hopefully, a reduction in denials and improved reimbursement. At the end of the day, who wants to put their money and reputation at stake?

So, what can you do to get the attention of your physicians? Honestly, not much has changed since I became a nurse 25 years ago:  as the cliché says, if you didn’t document it, you didn’t do it. For physicians, it’s the same deal; the services they provide must be clearly documented. It is our recommendation to focus physician training by specialty so that it is not so overwhelming. For example, if you are tasked to instruct an orthopedic physician, don’t focus on the increase in codes to approximately 1,800 with ICD-10; focus on their documentation to reflect “location, laterality, type of fracture and type of visit.” If your orthopedists focus on these four key concepts, they will lead your organization to clear, concise, and compliant ICD-10 coding.

Additionally, as you craft your physician training schedule, think about physician behavior. Physicians are multi-taskers by nature, so give consideration to this. Based on this notion, learning retention may be best accomplished if education is provided in small snippets. And lastly, it is well-known that physicians love their gadgets, and many can be motivated to learn the concise documentation requirements by allowing them to study them on their own electronic personal devices, such as iPads, iPhones, tablets, etc. Providing access to specialty-specific ICD-10 e-learning courses or an ICD-10 app will help faciliate learning and possibly motivate your physicians to master documentation requirements well before the implementation date of Oct. 1, 2014.

As the clock continues to click, think about ways to be creative with your physician education. Just remember, you are not the first to instruct a physician on documentation requirements, and you are not going to be the last.

To learn more about physicians and ICD-10, click on this link to a recently published WK whitepaper.

© 2013 CCH Incorporated

About the Author

Maria T. Bounos, RN, MPM, CPC-H, is the practice lead for coding and reimbursement software solutions for Wolters Kluwer.  Maria began her career at Wolters Kluwer as a product manager, responsible for product development, maintenance, enhancements and business development and now solely focuses on business development.  She has more than twenty years of experience in healthcare including nursing, coding, healthcare consulting, and software solutions.

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Maria Bounos, RN, MPH, CPC-H

Maria T. Bounos, RN, MPM, CPC-H, is the practice lead for coding and reimbursement software solutions for Wolters Kluwer.  Maria began her career at Wolters Kluwer as a product manager, responsible for product development, maintenance, enhancements and business development and now solely focuses on business development.  She has more than twenty years of experience in healthcare including nursing, coding, healthcare consulting, and software solutions.