Healthcare News & Insights

Where ICD-10 may hit your finances hardest

Hospitals are already expecting the transition to ICD-10 to impact their revenue, but one area could be hit especially hard — emergency rooms.

The good news: The Centers for Medicare & Medicaid Services (CMS) believes ICD-10 won’t be as disastrous for facilities as some feared, according to results from its ICD-10 end-to-end testing.

The biggest losses may come after the new code set is implemented, and when facilities and staff are still adapting to using ICD-10 full time. Initially, this would be due to errors in documentation and slowed productivity.

And independent research shows that emergency departments (EDs) may be affected the most by these issues after the transition.

Most passed ICD-10 testing

Healthcare Finance News reports that in CMS’ second phase of ICD-10 testing, 88% of claims filed passed evaluation, which is higher than the 81% success rate from phase one.

The testing consisted of 875 Medicare Administrative Contractors submitting 23,138 claims to its Common Electronic interchange.

Some have worried that ICD-10’s complex codes would lead to widespread coding errors, resulting in held or unpaid claims. However, CMS says only 2% of rejections were due to coding errors, and the rest were due to issues unrelated to coding.

The agency will conduct another round of testing at the end of July, but has already voiced its opinion that the latest testing proves most providers are ready for the change.

Initially, however, it may take time for clinicians to get the coding and documentation correct, which will affect some departments’ effectiveness and productivity.

ICD-10 and EDs

A new study published in the American Journal of Emergency Medicine says mapping ICD-9 emergency care codes to ICD-10 could impact workflow and finances.

Researchers at the University of Illinois at Chicago tried to evaluate the accuracy of mapping tools in translating commonly used ED codes to ICD-10. For data, the researchers analyzed a portion of the 2010 Illinois Medicaid database.

They found 27% of the 1,830 codes had complex, difficult mappings, which could lead to issues with reporting or reimbursement.

Even more troubling: Of the 622 complex ED codes, 23% were clinically inaccurate, researchers said.

The study also noted hospitals that staff EDs with independent physician groups are more likely to be overwhelmed trying to meet the new standards while performing their own billing.

To prevent these kinds of issues from growing and negatively impacting your ED’s revenue, hospital leaders and staff should take more time evaluating and translating commonly used codes.

It’s important to keep in mind that, although helpful, mapping and translation tools aren’t always 100% accurate, and may not choose codes that fully represent the services commonly delivered by your clinicians.

So take the time now to identify and manually translate your most commonly used codes, because the deadline will be here before you know it.


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