ICD-10 Launch Has Good Beginning
While there has been a great deal of analysis and punditry, industry hand wringing and anxiety over the transition to ICD-10, all indications are that it is off to a good start. Like the Y2K scare at the turn of the century, the go-live on Oct. 1 was widely publicized but relatively uneventful for the majority of stakeholders. In fact, in the first month after the transition, 99.9% of claims submitted to Change Healthcare were coded in ICD-10, and after almost two months the industry saw claims rejections and denials at the baseline.
After a lot of hard work, Oct. 1 appeared to be the grand finale, but what many are coming to realize is it’s only the beginning.
With the ICD-10 implementation deadline behind us, we are beginning to assess the future impact. We know that the granularity of the new coding set is advancing a number of the industry’s priority initiatives, including its move toward value-based care models and focus on providing higher-quality care. For example, for hospitals and health systems, ongoing investments in clinical documentation improvement (CDI) efforts should see an increase in dividends; driving these efforts forward and continuing to optimize them should remain a top priority.
In addition, providers will benefit from using analytics to effectively test post-implementation performance and help revenue cycle planning. Monitoring the entire revenue cycle process — from physician documentation to coding to claims management — using metrics can provide healthcare professionals with meaningful feedback, highlighting successes and noting areas where further improvement is needed.
Likewise, payers will want to continue monitoring and assessing their ICD-10 coding progress.
Although it’s still too early for health plans to know exactly how the timing of claim submissions, adjustments in DRG volumes and changes in error rates may impact long-term savings goals, robust data analysis can help closely monitor these trends and enable optimization on an ongoing basis.
Furthermore, clearinghouse networks will continue to add value by identifying submission errors, reducing costs through centralized workflow and enhanced automation, and providing insights for smarter decision making.
In the meantime, payers should continue best practice efforts around provider education and outreach. Just as they have over the past several months, payers can continue to communicate ICD-10 policy and changes in advance and allow providers time to plan appropriately.
Even in the early stages of the transition, watching key data points will help payers and providers reap significant benefits from ICD-10. For example, health plans and clinicians agree that reducing or eliminating fraud, waste and abuse are worthy goals. The increased granularity of ICD-10 data is likely to drive significant improvements in this area now and well after the transition.
The increased specificity also offers the potential for cost savings through more accurate trend and cost analysis. Furthermore, ICD-10 has the potential to improve payers’ and provider organizations’ ability to monitor resource utilization, outcomes and performance.
The most impactful projection for ICD-10 is how it will affect the patient. ICD-10 code sets will allow for more accurate data about patient health to be recorded and tracked. Ultimately, when monitored over time, this allows for patterns to be identified—whether that be around particular chronic diseases, efficacy of care plans or fraud, waste and abuse.
No doubt there will be bumps in the ICD-10 road. But for all the anxiety over making investments in technology, people and processes to meet the ICD-10 implementation deadline, the increased coding accuracy will, in the long run, pay big dividends for payers, providers and — most importantly — for patients.
Dave Cardelle is the Senior Vice President of Operations, payment integrity services, and Mike Denison is the Senior Director, regulatory compliance programs, at Change Healthcare.
