February 20, 2014
We all know that healthcare organizations need to fold many considerations into their ICD-10 implementation plans. These include impacts on physicians, coders and other staff, the interrelationships between ICD-10’s more detailed coding requirements with Meaningful Use / MIPS, and negative impacts on claims transactions and the revenue cycle. But what about the impacts on our patients?
HealthcareITNews recently posited that ICD-10 may well improve patients’ satisfaction with their providers, noting that current patient satisfaction surveys are often returned with negative reactions if the patient received an unexpectedly high bill — no matter how effective the treatment or how positive the customer service experience. Central to this problem is that patients often don’t know up front what the bill is likely to be; the shock is pulled out of the mailbox a month or more later.
In theory, caregivers with freshly minted ICD-10 information should be able to provide much more detail about both the diagnosis and procedures to the patient at the point of service. That may occur, in time. ICD-10 codes better describe the gravity and complexities of a patient’s condition, which will greatly help in validating the need for specific services and procedures with patients.
But, let’s hold on a moment and consider a few painful realities coming along with ICD-10, that will undoubtedly affect patient satisfaction in the short run.
It is likely that, from the moment a patient embarks on a diagnosis and treatment experience post-October 1, new issues in code interpretation and communication will occur, especially in the first several months after the transition. For example, intake staff may have to review the order, determine whether ICD-9 or ICD-10 use is applicable (not all payers will convert right away). If dual coding is in place, both ICD-9 and ICD-10 will need to be applied. If the diagnosis is unclear, or can’t be easily translated, the physician’s office needs to be contacted to clarify, and patients will wait longer. Overall, if appropriate codes are not provided for whatever reason, multiple delays in registration and scheduling the service will occur, and have a negative effect on patient satisfaction.
Further, if eligibility determination is delayed or not completed before a patient receives service — and the payer eventually determines it wasn’t a covered benefit — the patient will be confused and understandably upset.
To mitigate such risks to the intake process, eligibility determination processes and procedures, including dual-coding situations, must be thoroughly reviewed and upgraded. In addition, registration staff will need basic training in ICD-10-CM and ICD-10-PCS. Deployment of a registration-auditing tool that checks the accuracy of the patient data collected will also be helpful.
Considering the increased complexity and time intensiveness of the patient’s registration and eligibility adventure once ICD-10 is in action, let’s face it — at least for the first year or more after the ICD-10 transition, it seems unlikely that most healthcare organizations will be able to take the time to provide more information about services and costs to patients upfront, even with the availability of more detail. Patients will still be dismayed by unexpected bills for services.
Billing and Claims Delays
Provider organizations already know to expect decreases in coder productivity, as newly trained or retrained coders get up to speed on ICD-10. It’s well established that the act of recording more data elements will take more time, though the addition of more coders to staff should help. Coders will have to contend with inadequate documentation, requiring them to make more physician inquiries. Additionally, coders will be slower while they are in a dual coding mode.
These coding delays will slow down billing in provider business offices. Also, many bills may be inaccurate either due to coder error or improper initial documentation. For example, recorded ICD-10 procedure codes may not match up with stated ICD-10 diagnosis codes. Such issues may increase the necessity for rebilling.
There are enough variables created by the coding transition that the entire claims process will take longer – for a long time to come. Claims will be initiated later, and receive lengthier scrutiny by payers, as well as more denials. This will result in slowed claims payment by payers before patients receive their portion of the medical bill. ICD-10 will create new reasons for significant delays between the time of service and the time the patient receives the bill. Increased patient satisfaction? We probably can’t expect it from this direction.
The Bright Side
On the other hand, ultimately, ICD-10 will benefit patients by allowing the capture of new, more detailed data to enhance patient safety and outcomes. ICD-10 codes will generate more detailed healthcare data, and create a greater flow of data that will improve medical communication, literally, around the world. Many healthcare providers, public health experts, IT professionals and researchers are excited about this. So are we. One expected result will be improved disease management that should contribute to advanced disease protocols and clinical pathways, leading to higher-quality care and improved outcomes.
Patients may also benefit on the financial side. The greater accuracy of ICD-10 should increase the likelihood that they are billed appropriately, and that they receive proper payment from both government payers and private insurers. Their providers will give them proper credits, and charge them less often for unnecessary procedures.
As hospitals and practices move forward on their ICD-10 roadmaps, they should be focused on finding ways to manage the negatives and capitalize on the positives. Thus far, much of the dialog about these extremes has centered on impacts to the providers, and their internal staff and operations. Without a doubt, this is appropriate. However, it would be good to start hearing more about how we will make ICD-10 work for our patients, as difficult as that objective may seem today.