Small hospitals playing ICD-10-guessing game with payers

With only a year until the ICD-10 transition, smaller hospitals have jumpstarted their staff training but still lack preparations to work with payers, according to a new survey from Health Revenue Assurance Holdings (HRAA).

The survey involved 200 hospital administrators, hospital health information professionals and compliance employees and found 78 percent have started ICD-10-CM training for coding staff, up from 60 percent last quarter. And 64 percent of hospitals have begun training coding staff on ICD-10-PCS, up from last quarter's 45 percent.

While providers should plan for 16 to 24 hours of training for clinical staff and 40 to 60 hours for coding staff, everyone from the appointment scheduler to midlevel providers to physicians must understand specific documentation, medical necessity and third-party payer guidelines under the new code set, FiercePracticeManagement previously reported.

In addition to increased training efforts, the HRAA survey found small- and mid-sized hospitals also are focusing on improving clinical documentation, with 68 percent providing medical staff with document improvement education, compared to 53 percent last quarter.

"The not-so-good news is that they are not putting enough resources against understanding how their payers will operate once the ICD-10 transition takes place," HRAA Chairman and CEO Andrea Clark said in the survey announcement.

For instance, 72 percent of hospitals don't know if their payers intend to use the Centers for Medicare & Medicaid Services reimbursement maps to group the claims to DRGs while 85 percent still haven't found out how their payers are mapping claims, according to a related infographic.

The survey findings suggest hospitals are opening up their organizations to substantial claims denials and delayed payments when the transition kicks in next October. So hospitals need to implement financial modeling and denial strategies now to avoid playing a guessing game with payers.

Provider-payer coordination is key to ensure a smooth transition to the new code set. With that in mind, Independence Blue Cross, which expects to be ready for ICD-10 implementation, has launched an outreach program and testing program to boost the provider community's ICD-10 readiness, FierceHealthPayer previously reported.

For more
- here's the survey announcement
- check out the related infographic (.pdf)

Suggested Articles

Physician groups slammed a court ruling that overturns CMS' site-neutral payments rule for clinic visits.

As the DEA proceeds with the rulemaking process for the Special Registration process, it needs to address important public health priorities.

In a huge win for hospitals, a federal judge has tossed the Trump administration's rule instituting site-neutral payments.