Exactly one year out from the transition, more small and mid-sized hospitals are taking steps to prepare for the implementation of ICD-9 to ICD-10, but still but lag when it comes to payer preparations, financial modeling, and denial strategies, according to a new survey by Health Revenue Assurance Holdings (HRAA), a Plantation, Fla.-based coding vendor.
While the results showed that hospitals are focusing on employee training, the survey of 200 hospital administrators, hospital health information professionals, and compliance employees also revealed that they are leaving their organizations exposed to massive claims denials when the transition takes effect.
This is because they do not understand what ICD-10 codes will be accepted by the payers as it relates to reimbursement maps and diagnosis-related group (DRG) groupings. Additionally, they are lacking denial strategies and financial models to help them avoid what could be a colossal claims backlog post-transition, the survey said.
The survey is a follow up to industry research conducted by HRAA in April, which revealed more than half of hospitals were not complying with Centers for Medicare and Medicaid Services (CMS) suggestions and were falling behind the curve.
Of the hospitals surveyed:
• 78 percent have begun ICD-10 CM training for coding staff, compared to last quarter’s 60 percent
• 64 percent have begun ICD-10 PCS training for coding staff, compared to last quarter’s 45 percent
• 68 percent have begun document improvement education for medical staff, compared to last quarter’s 53 percent
• 76 percent plan to dual code prior to October 1, 2014, compared to last quarter’s 69 percent
While 71 percent of hospitals plan to submit ICD-10 coded claims to payers prior to October 1, 2014, they are not taking the initiative to understand how their payers are mapping their claims, which leaves them vulnerable to excessive denials and a slowdown in reimbursements.
Eighty-five percent stated that they do not know if their payers are planning to map claims utilizing CMS reimbursement maps to group the claims to DRGs. Internally, less than half (42 percent) stated that they plan to use CMS reimbursement maps to evaluate DRG groupings compared to those based on the ICD-10 grouper.