Fast track. That’s what it’s going to take to get your practice both into compliance and in shape to take advantage of ICD-10’s reimbursement benefits.
KPMG’s target is that by the summer of 2014, both providers and payers need to be testing for the go-live in October, according to Wayne Cafran, KPMG’s advisory principal for healthcare and life sciences.
But as of now, the consultancy found in research published on Jan. 8, many healthcare entities are lagging behind that timeline in terms of budgeting, testing, training and bracing for the permanent productivity losses that ICD-10 is expected to bring.
All that despite the finding that 73 percent of respondents fully anticipate moderate to severe revenue cycle impacts, coming largely in denials management and claims preparations and edits.
Where it gets worse is the general consensus that large health organizations tend to be further along than medium and smaller medical groups, an assertion several consultants and recognized experts have made to Medical Practice Insider through the last few months.
“The larger systems have indeed started earlier,” Cafran explained. “The mandate, of course applies to all payers and providers equally.”
Medical practices can catch up if they do these three things right:
1. Clinical documentation implementation programs, or CDI, is an area of increasing importance. By starting to focus on CDI requirements today, in fact, healthcare organizations can do more than merely comply with ICD-10; instead they can even optimize reimbursement. But KPMG found that the top CDI challenges are educating staff and understanding documentation complexities and nuances, neither of which can feasibly be ironed out overnight. And while 34 percent of those surveyed indicated they have implemented enhanced CDI strategies for ICD-10, 48 percent remain unsure if they have or will.
2. Recruitment, training and retention of coders. These professionals must quickly get up to speed on the new codes. “From a provider perspective, it’s not just the coders who have to be properly trained but physicians as well to prevent disruptions when ICD-10 is implemented.” Cafran said. And when it comes to those permanent productivity losses, 45 percent have not even calculated that impact, and among the ones who have, 22 percent expect a dip of 11-20 percent.
3. Ensure IT systems are ready to interface for data quality. Easier said that done. More than systems remediation for the 7-digit codes, this will tie back into internal and external testing of which 42 percent of respondents are currently doing so, 24 percent are not but plan to, while the remaining 34 percent are unsure when or if that will happen. When it comes to end-to-end testing, only 33 percent are conducting that today, 28 percent plan to, 36 percent are unsure. And 3 percent indicated that they do not plan to engage in end-to-end testing at all.
Cafran added that if medical practices can manage to correctly perform those 3 pieces of the ICD-10 transition they will be approximately 80 percent of the way there.
“If you have not started your implementation plan, is it impossible to get ready at this time?” Cafran asked rhetorically. “It’s not impossible but you need a quality assessment and a flawless execution of your implementation strategy — and that needs to happen now.”