ICD-10 Aftermath: How did your hospital fare?

February 16, 2016

We’ve made it through the first three months of ICD-10. How is your organization doing? Did lighting strike? Did the ground open up and swallow your hospital or practice? Probably not. But you did experience some sort of change, some growing pains, and most likely you surprised yourself with how smoothly almost everything else went.

What changed? We want to know how. AppRev is conducting a post ICD-10 Implementation Study to take a look back at six crucial months of data: the last three months under ICD-9 compared to the first three months under ICD-10. We’ve received some data so far, but there’s always room for more. The more, the merrier, in fact!

From you, all we need is a small amount of data entered into a simple spreadsheet. We’ll do the rest – from analysis and comparison to organizing and publishing the results. AppRev will announce the results of the study at HFMA Region 5’s Annual Dixie Institute on March 21, 2016, in Nashville, then the results will be released to the general public through ICD-10 Monitor’s Talk Ten Tuesday podcast on March 22, 2016. Afterward, the complete results will be made available during AppRev webinars, at HFMA conferences, on our website at www.apprev.com and upon request. Want a copy of the results? No problem. Just ask and we’ll send them your way.

(Please note: No hospital or practice names will be published. We know you value the integrity of your organization’s privacy and security. All information will remain confidential. We’re just interested in the numbers and trends).

So, exactly what information are we looking for?

We’re gathering the following Key Metrics:

  • Days Cash on Hand
  • Discharged Not Final Billed (DNFB) in Charges
  • Net Days in A/R.

Regarding Denial data, we’ll be collecting the following:

  • Initial Denial Rate
  • Authorization – Percentage of Initial Denials
  • Authorization – Number of Denials
  • Medical Necessity – Percentage of Denials
  • Medical Necessity – Number of Denials

Would you like to see how your organization’s performance compares to the experiences of a larger group? Then join the party! This is an opportunity to be a part of something that no one else is doing. There will only be one ICD-10 transition.

Have any questions or want further information? Please contact us. We’ll be happy to talk to you about the study and our plans for use and distribution of the data. See complete details (including a download of the spreadsheet) here: http://apprev.com/icd10-study.php.

We’re looking forward to meeting you and seeing how things have played out for your organization under ICD-10!

 

 

 


Medical Necessity, Denials and ICD-10

March 18, 2014

While working with one of our customers on our Denials Intelligence, I was asked about ICD-10 and its impact on denials.  I have a position on this that I would love to share.  I see three issues related to, denials caused or increased.

Inpatient Coding

Currently, ICD-9 is primarily used for inpatients to group DRGs and denial risk is limited to payers that use ICD-9 for reimbursement.  So, providers will document.  Coders will code.  Groupers will group.  The potential breakdown will occur where the documentation or coding is not specific enough to create a groupable DRG.  In “denial speak”, that should be a Claim Adjustment Reason Code (CARC) “A8”.  I assume if you have those in your data now, you will have those and more with ICD-10.

Outpatient Coding

Ditto for inpatient coding with the complexity of medical necessity.  ICD-9 codes are used in the outpatient setting primarily for medical necessity.  I am guessing that few payers, outside of government, perform automated medical necessity checks.  Those claims subject to medical necessity must pass either National Coverage Determination (NCD) or Local Coverage Determination (LCD) edits to be paid.  While the ICD-10 grouper has been around for over three years, we have not seen the LCD and NCD tables yet.  They are expected to be released in April, 2014.  If you are getting these denials now, in denial speak that should be a CARC “50”.  I assume if you have those in your data now, you will have those and more with ICD-10.  I would be interested to know what other CARCs payers are using to indicate lack of medical necessity.

Contractual Terms

On occasion, payers will have terms that are specific to ICD-9 diagnosis or procedure codes.  This is another source of potential ICD-10 denials.  Providers will have to work with payers to determine which ICD-10 codes are replacing the ICD-9 in the contracts.

Conclusion

A wise man recently said to me, “If you expect your denials to double under ICD-10, then you better cut them in half now.”

For more information on ICD-10 readiness and Denials, please visit our website.


%d bloggers like this: