The clock is ticking louder for the ICD-10 go-live date in October 2014. As it does, health systems are beginning to fret about the likely financial impact on operations. Speakers at the Healthcare Financial Management Association conference in Orlando described the journey to ICD-10 as both arduous and full of uncertainties.
Sutter Health, a $9.1 billion health system with 24 acute care hospitals across northern California, began its transition program in 2013, noted HFMA panelist Danielle Reno, ICD-10 program director. Sutter’s 14 transition teams--which report up to a senior level executive sponsor--represent the breadth of the challenge, which impacts information systems, revenue cycle, contract management and multiple other areas. Sutter is about three-quarters of the way through its financial analysis of ICD-10’s likely impact--a key consideration in determining where to focus clinical documentation improvement and coding training resources, Reno said.
Using claims grouping and cross-walking tools from CMS, Sutter determined that about 8 percent of its claims mapped to Medicare DRGs would shift to another DRG under ICD-10. Medicare offers a cross-walk tool known as GEMs, or general equivalency mappings. Using the cross-walk, health systems can identify which cluster of codes in ICD-10 would correspond to a counterpart in ICD-9. Reno noted that the GEMs tool, while a good starting point, still requires a great deal of manual review due to the one-to-many relationship between versions 9 and 10--which includes tens of thousands of new codes.
Sutter is also conducting “table top testing” of ICD-10 with two commercial payers. Rather than submitting test data through its billing system, the process involves sending raw ICD-10 data on a spread sheet, which the payer can parse and analyze for errors and omissions. The effort requires pulling coders from their normal duties however and Reno cautioned that as health systems go through the exercise, they may discover a correspondent drop in cash flow as it could take longer to get real claims out the door. Sutter budgeted for additional coding support during the initiative, she noted.
Panelist Brett Kelsey, chief revenue officer at Lucille Packard Children’s Hospital, serves as executive sponsor of the pediatric facility’s ICD-10 transition team. Part of Stanford Health System in California, Lucille Packard has mostly completed its information systems and financial impact analysis. It’s now renegotiating payer contracts in areas most likely to be heavily affected by ICD-10.
But Kelsey and other panelists sounded one common theme: there is a great deal of uncertainty inherent to the transition to ICD-10. Packard, for example, is looking for a vendor partner to assist with cross-walking data from ICD-9 to ICD-10, noted Kelsey. And as Reno pointed out, even after training, coders may not agree on which particular ICD-10 code to apply to a given case--even if physician documentation is thorough.
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