Survey: Hospitals Lag in Payer Preparations for ICD-10

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Hospitals have ramped up their staff training efforts in preparation for ICD-10, but many still don't understand how their payers are mapping their claims, leaving them vulnerable to massive claims denials, according to a survey conducted by the consulting firm Health Revenue Assurance Associates.

DoctorThe transition from the ICD-9 code sets used to report medical diagnoses and inpatient procedures to ICD-10 is required for everyone covered by HIPAA starting Oct. 1, 2014. The HRAA survey — a follow-up to industry research HRAA conducted in April — found 78 percent of hospitals have begun ICD-10-CM training and 64 percent have started ICD-10-PCS training for their coding staff, up from 60 percent and 45 percent respectively in April.

Furthermore, 68 percent have begun document improvement education for medical staff, up from 53 percent last quarter. Seventy-six percent of survey respondents plan to dual code prior to Oct. 1, 2014, compared with 69 percent in April.

However, the survey also found hospitals are lagging behind in some areas. Although 71 percent plan to submit ICD-10 coded claims to payers before Oct. 1, 85 percent of hospitals stated they don't know if their payers plan to map claims using CMS reimbursement maps to group the claims to diagnosis-related groups, according to the survey.

Many hospitals aren't putting enough resources into understanding how payers will operate when ICD-10 takes effect, Andrea Clark, chairman and CEO of HRAA, said in a news release. Ms. Clark said hospitals should implement the necessary technology to do financial modeling and come up with claims denial strategies now to make the transition easier.

For more information, view an infographic based on the HRAA survey here.

More Articles on ICD-10:
CMS Reinforces ICD-10 Importance During Health IT Week
Study: The Far-Reaching Implications of the ICD-10 Transition 
CMS Updates ICD-10 General Equivalence Mappings 

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