Considering the industry-wide concern ahead of the October 1, 2015 implementation of the International Classification of Disease, Tenth Edition (ICD-10) coding standards, the transition seems to have gone relatively smoothly. Generally, the worst case scenarios - interruptions in practice cash flow and negative impact on coder productivity - did not happen, which is great news to hear.
In late April and early May, Merge Healthcare, an IBM Company and a leading provider of medical imaging solutions, interoperability and clinical systems, surveyed its customers on their experiences six months into the switch to ICD-10. Almost all customers who responded to the survey had their own staff certified ICD-10 coders. They reported similar coder productivity on ICD-9 and ICD-10. In addition, no respondents said that they had noticed an increase in specific claim denials so far.
“It is encouraging to see that the switch to ICD-10 went relatively smoothly for our customers,” says Shannon Marshall, solutions manager for radiology workflow at Merge. “The solutions we’ve developed for the radiology market are designed to be vendor neutral and flexible. Tools like our auto-coding feature can be helpful as coders gain experience with ICD-10. In addition, solutions such as Merge Financials™ and Merge Dashboards™ also gather valuable data and present it in an actionable format so that our customers can better manage all aspects of their businesses, including claims. For example, the solutions can help quickly detect an uptick in certain denials so that our customers can do a root cause analysis and fix the problem before it has a more major impact on practice financials.”
Still, ICD-10 is an evolving situation. Keep in mind that after October 1, 2016 (12 months post-ICD-10 implementation), Medicare review contractors will begin to deny claims with an incorrect level of ICD-10 specificity. As Medicare administrative contractors, the recovery audit contractors, the zone program integrity contractors, and the supplemental medical review contractors begin to flag claims without the appropriate level of specificity, denials may very well begin to creep up.
“It is important to have tools in place that allow you to monitor all aspects of practice performance, especially denial tracking for claims,” Marshall says.
The Merge solutions work together to track denials with customizable reports and work queues, she explains. In addition, these work queues can be customized to allow specific types of denials to go to the appropriate staff for review and resolution. The result? A practice that can quickly build up internal experts on certain denials types and maintain visibility into its operations for better payment assurance. Having a deeper understanding of your process and maintaining constant touchpoints within your workflow are imperative to navigate your practice forward during changing tides.
“For example, not only can you route a specific subset of denials to one person, but you can have that same person work with the Medicare denials for that subset of codes while another person does follow up for the commercial payers for those codes,” Marshall explains.
And because Merge’s financial and dashboard tools integrate with its other solutions for RIS, PACS, scheduling, referrals and more, the solution packaging can be customizable and scalable for a practice’s exact needs. To learn more about Merge solutions, visit http://www.merge.com/Solutions/Radiology.aspx