ICD-10 Impact for Providers

Although providers must also implement the same 5010 electronic transactions and ICD-10 code sets as payers, the challenges faced by providers are much different than those faced by payers. For providers, this compliance effort introduces ICD-10 into the clinical process. Among the primary challenges are training needs, system needs, and revenue cycle management issues.

By using a Change Leadership/Business Process Reengineering methodology, providers can obtain the commitment of physicians and staff to an effective implementation effort.

Training Needs

In order to ensure a smooth claims submission process, coders will need to be able to extract a greater degree of detail from the courses of treatment documented by the physicians. To make sure that the physicians are aligned with the coders, all parties must undergo intense training on the differences between ICD-9 and ICD-10. If the training is lacking and ICD-10 is not otherwise implemented correctly, providers can expect a significant decrease in physician productivity, an increase in rejected claims, and a disruption to the revenue cycle.

The clinical documentation and charge capture/coding processes must be reengineered. Providers can continue use of common medical terminology (CMT), such as SNOMED CT, as long as they use an electronic medical records product (EMR) that can map the CMT to the ICD-10-CM and ICD-10-PCS common classification system (CCS).

System Needs

Providers should use an EMR to automate the coding process. Increased automation is especially important in light of estimates suggesting a 50 percent decrease in coder productivity. Again, the EMR must be able to map the CMT to the CCS. Reliance upon standardized terminology sets lends itself to greater interoperability with other EMRs and maximizes the benefit of capturing outcomes data and for payment purposes.

Despite the challenges facing providers in this compliance effort, if conducted properly, the reengineering effort and increased automation can lead to an increase in clinician productivity.