Just as a recent ICD-10 readiness survey by Health Revenue Assurance Holdings (HRAA) has shown that a significant majority of hospitals has turned the corner when it comes to training staff, it has also revealed a serious deficiency in hospitals engaging with third-party payers, a lack of communication that could prove financially crippling if not addressed prior to Oct. 1, 2014.
According to HRAA CEO and Chairman Andrea Clark, the signs are at least positive for one-half of the ICD-10 equation (i.e., staff training and education).
“The turnaround was due to the fact that after the extension was put into place now budgets have been opened up to choose the vendor of choice to begin that education and training,” she says. “Also, there is a mindset that you don’t want to train too far out or you don’t want to train too close, so it’s right at a sweet spot that they can do the fundamental CM and PCS training and allow the coders to apply and assign the ICD-10 in order to start reviewing data pre-Oct. 1, 2014.”
But all this preparation on the hospital side could ultimately prove pointless unless healthcare organizations and providers take the necessary steps to work with their payers. “That makes me anxious for the hospitals because of the fact that that communication has not been opened and they really don’t know what their predictive financial model is going to be and how they can manage that or control it or educate the payer before Oct. 1, 2014,” observes Clark.
A sticking point with the potential to become a major pain point depends on the use of general equivalency mappings (GEMs) and diagnosis related groups (DRGs), which may vary from payer to payer.
“Best practice has to do with data, and hospitals are data rich,” explains Clark. “In fact, utilizing our clients and our technology and asking for data for a year’s worth of inpatient and outpatient claims, they need to be able to translate from ICD-9 to ICD-10 utilizing the GEMs and be able to take a look at if a payer is going to group and use a grouper in ICD-10 or are they going to take the ICD-10 codes and group them back to an ICD-9 DRG grouper.”
