ICD-10: where does EHR stand six months on?

The ICD-10 deadline came and went with little fanfare. Perhaps the relatively humdrum way in which this much-debated and sometimes-derided deadline passed rests in the fact that the transition process had been on the agenda of a vast majority of providers for some time.

It was likely that the ICD-10 transition was treated as just another in a long line of changes in the healthcare regulatory landscape, much like many of the other reforms implemented over the last five years. Looking at the pre ICD-10 transition predictions on their face one could have easily assumed that the US healthcare system would have descended into coding chaos. In reality, the impact from ICD-10 was less than detrimental than anticipated,at least for now. However the long-term transformative impact ICD-10 will have on the EHR market will likely benefit practices as it provides the necessary tools for more nuanced data collection and analysis.

ICD-10 and claims data.

One prediction before the transition date stated that providers would experience significant problems related to claims processing. Initial data released by the Centers for Medicare and Medicaid Services (CMS) indicate that the total claims submitted after the ICD-10 deadline were on par with historical baseline data of 4.6 million claims per day. The percentage of claims rejected in the last quarter of 2015 dropped slightly from the baseline level of 2% to 1.9%. Looking at the percentage of claims denied since the ICD-10 transition, denials decreased from the baseline of 10% to 9.9%.

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Based on the preliminary evidence it appears that the predicted problems related to claims processing did not come to fruition.. However, we must bear in mind that ICD-10 had been in place for three months when the CMS data was tallied. Three months of data is a small sample size that likely will not represent the range of potential problems that could emerge given a larger pool of data to analyze.

ICD-10 and productivity.

The second area of ICD-10 related trepidation involved drops in productivity among providers who must adapt to the more complex coding scheme. A recent study conducted by Primeau Consulting Group showed that 66% of those surveyed had experienced reductions in productivity due to ICD-10. These productivity losses ranged from 25% to 35%. Further 34% of respondents reported negative impacts on their revenue cycle since adopting ICD-10.

These results can be contrasted with a Navicure survey that showed 60% of respondents did not experience an impact on monthly revenue while 34%experienced a decrease of up to 20%. Denial rates remained the same for 45% of respondents, with nominal increases (under 10%) for 44% of the participants. These data show that any solid conclusions arising from ICD-10 are likely premature.

Over the long term, the impact from ICD-10 will likely begin to work for providers as the coding scheme becomes the new normal and as EHRs begin to leverage ICD-10’s more nuanced data. As EHRs begin to incorporate more sophisticated analytics, ICD-10s usefulness in the day-to-day business of healthcare will begin to emerge as practices can use ICD-10 coding data to monitor metrics related to risk and quality of care. When coupled with the fact that productivity drops resulting from ICD-10 adoption will eventually diminish the claimed tangible benefits of ICD-10 may become clear.

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Jeff Green

About the author…

Jeff Green, MPH, JD works as a freelance writer and consultant in the Healthcare information Technology Space.

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Jeff Green