Enterprise Imaging Blog

Grace is Gone: The ICD-10 Period of Relaxed Rules is Over
Alternate text Posted by John Clarke on 10/1/2016 8:10:12 AM

Grace is Gone: The ICD-10 Period of Relaxed Rules is Over
As you may know, October 1 is the anniversary of the ICD-10 switch over, and thus, ends the ramp up or 'grace' period.  The relaxed approach payers have taken throughout the delicate switch from ICD-9 to ICD-10 also coincides with the finalization of MIPS1, which will come later this fall.  With these initiatives looming, the question everyone is asking is simple: 'Is my organization ready to embrace these changes?

This time last year, organizations braced themselves for ICD-10 coding, but most Merge customers found that their preparation and education helped quash any fears about their workflow being interrupted by the transition. Merge Financials™ helped streamline the switch by incorporating a cross-walk tool to assist coders and/or back office staff with embedded ICD-9/ICD-10 compatible codes for either set. During this time period, denial rates did not increase for Merge customers.

Specificity in coding is the new challenge, as payers will have to pay closer attention to unspecified codes that were a crutch during the grace period. Payers will no longer allow unspecified codes to be the catch-all for physicians diagnosing patients. As we transition further into ICD-10, payers will request more specific coding information and chart audits which will lead to more claims denials, delay reimbursements, and result in punitive measures.

While many clinicians and their back office staff cling to the familiar volume-based care model (and the reimbursement levels that come with that approach), the need to pivot to value-based care grows more pressing with each passing day. As mentioned above, the final ruling for MIPS is fast approaching, and being able to measure and report has a direct correlation to ICD-10 coding. If anything was learned from this past year of implementation, it's that detailing clinical documentation in order to understand the health of a practice is not only a best practice, but a necessity.  Merge Financials helped practices become more diligent with their reporting during the ICD-10 mandate, and that approach will also be helpful as they transition to MIPS.

This new era of coding and reporting in a value-based healthcare world will further push organizations to incorporate more IT resources into their practice workflows.  Adapting to the higher level of specificity and being able to measure value-based care depends on leadership engaging vendors and partners that align with their practices' strategic goals.  Trying to build in-house solutions only detracts from the primary function (and focus) of valuable IT staff.

With a multitude of vendors to choose from, it can be difficult to know which tools can truly help practices and organizations.  But preparing for this new world doesn't have to be a daunting task.  Answering these simple questions will put you on the right path:

  • Are we equipped to handle ICD-10 completely?
  • Is our interoperability effectively working for us while satisfying reporting mandates?
  • Can our practice management system(s) automate these processes?
  • Are vendor solutions widget-based, or customizable to my practice and our workflows?

If all the boxes are checked 'yes' you have a solid foundation to build from.  If any of these are marked 'no' it's time to revisit your growth strategy.  So, happy one year anniversary ICD-10 (and your 2,000 updates)… we look forward to the challenges we will overcome together.

1 Merit-based Incentive Payment Systems

Share on: Add to Twitter Add to Facebook Add to LinkedIn
<< back to blog home

Enterprise Imaging Blog

Our blog covers topics related to medical images, including how to safely and securely archive, manage and share these important pieces of medical information. We also discuss issues related to imaging, such as industry trends, government regulation, reimbursement changes and much more.

Subscribe Via Email

Follow Merge

Search the Blog

© 2018 IBM Watson Health. All Rights Reserved. Privacy | Terms | Email Signup | Sitemap