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In the past year, the spectacle of clashing interests, priorities, and agendas of the public and private sectors of America’s healthcare system played out in the electronic pages of ICD10monitor’s e-newsletter, which chronicled the turmoil leading to the adoption of the International Classification of Diseases, Version 10 (ICD-10).

There it was for all in the healthcare industry to see, read, and assimilate – and, ultimately, on which to take action. If nothing more, ICD10monitor managed to open communication between the guardians of some protected turf: hospital administrators, physicians, nurses, coders, documentation improvement specialists, chief financial officers, IT engineers, and more. At stake was how hospitals, health systems, physician practices, rural hospitals, and teaching facilities would migrate from ICD-9, which was more than 30 years old, to the new version of ICD-10.

The opposing factions were rigorous in their firmly held beliefs. The American Medical Association (AMA) led the fight for delay, taking their case to Capitol Hill and soliciting congressional help and urging government officials such as then-Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn B. Tavenner to delay the adoption of ICD-10. They even looked to involve former U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius.

All of this tug-of-war was reported on by ICD10monitor via 884 stories and special bulletins published right up until the arrival of the mandatory ICD-10 compliance date of Oct. 1, 2015 for all HIPAA-covered entities.

Now, eight months later, the American Health Information Management Association (AHIMA) has published an analysis of ICD-10 in the June edition of its Journal of AHIMA, “Analyzing Eight Months of ICD-10.” 

The occasion of the publication prompted the following interview with Sue Bowman, MJ, RHIA, CCS, FAHIMA: AHIMA’s senior director of coding policy and compliance. Bowman continues to be a popular guest on Talk-Ten-Tuesdays and will return on this morning’s live broadcast, 10 a.m. EST. 

From Bowman we wanted know not only about the kinds of lessons to be learned, but also what might be the next major issue that will grab the attention of healthcare professionals – or, as Denise Buenning, formerly with CMS, asked, “what is the next big passion in healthcare…that people will go to the mat for?”

ICD10monitor: What is the biggest takeaway from the ICD-10 implementation and why?

Bowman: Effective communication, education, and industry-wide collaboration are essential to the success of a transition of this magnitude. Early, active engagement and commitment by all stakeholders is also critical. The transition to ICD-10 was relatively smooth, with none of the dire predictions that had delayed the transition for so many years coming true. Earlier education, aimed at all stakeholders, around the purpose and benefits of the transition and aggressive outreach efforts early on in order to widely disseminate accurate information about ICD-10 and the implementation process might have lessened the proliferation of misinformation and the damaging impact it had on achieving a timely transition to a much-needed code set upgrade.     

ICD10monitor: What is the next big thing on the horizon for healthcare, and how does it impact health information management (HIM)?

Bowman: Data analysis is a key topic on the horizon for the healthcare industry as a whole. Statistics are showing that hospitals are experiencing up to a 15-percent decrease in inpatient admissions. Additionally, over 700 hospitals closed last year, and more (are) expected to close in 2016, acquisitions/mergers are up, physicians are selling their practices to go to work for the hospital. All of these decisions are based off data. Health information management (HIM) is mired in data, and our professionals have been reviewing and maintaining data since 1928. It’s important to understand how lab data affects and relates to medication usage, patient health, readmissions, ICD-10 codes, and several other areas in healthcare facilities.  

ICD10monitor: How will AHIMA further train coders?

Bowman: AHIMA has created an advanced coding program in ICD-10-CM and ICD-10-PCS to further train coders. We also continue to produce the CodeWrite newsletter, providing further education through examples. We have virtual meetings that reinforce previous instruction in ICD-10, and we are providing a series of code update webinars to assist … coding professionals with the large amount of new and revised ICD-10 codes.

ICD10monitor: When do you think the full impact of ICD-10 will be known? Are you expecting claims rejection/denials data to change dramatically from the first eight months of results?

Bowman: It will probably take one or two years before organizations know the full revenue impact of ICD-10. Payers are making adjustments to payment policies to correct code translation errors, such as the extensive modifications outlined in the hospital inpatient prospective payment system for the 2017 fiscal year, which will make the revenue impact somewhat of a moving target for a while. In terms of data trending challenges (between ICD-9 and ICD-10 data), it will probably be at least a few years before they will be fully understood. In terms of the impact of better data on measuring and improving quality of care, that will take even longer – probably a number of years.

We do not expect dramatic changes in claims rejections/denial rates. Many payers and providers have been reporting pretty low rates all along. While there have been some increases in denials and rejections, these have been due to translation errors in payment policies, which are gradually getting corrected and will stop occurring. 

ICD10monitor: How will the latest payment methodologies (e.g. Comprehensive Care for Joint Replacement, or CJR) and regulations (Medicare Access and CHIP Reauthorization Act of 2015, or MACRA) impact HIM?

Bowman: While it is too early to say for certain, we know that high-quality coded data and complete, accurate clinical documentation are critical to these new payment models. For example, the care episode groups required by MACRA are defined by diagnosis and procedure codes. Therefore, more emphasis will be focused on the quality and accuracy that go into these models.


Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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