Document Type

Research Project

Publication Date

2014

Abstract

The transition from ICD-9CM to ICD-10 CM for hospital providers was reviewed to identify the impact. The study will incorporate history of the change, lessons from other country adoptions, and a comparison of static industry survey results with more dynamic results from the 2014 Johnson survey for this study. Remediation and critical success factors will also be outlined. Results include financial impact and concerns from the literature review as well as participant survey feedback from payors, healthcare consultants, and hospital employees in health information management, financial analysis, patient financial services and information technology. For the 2014 Johnson study, twenty-one surveys were submitted; 17 hospitals (two multi-hospital systems; one with two hospital and the other a forty hospital system, both systems were counted as two hospitals), three payors, two consultants; eleven total respondents; overall survey completion rate was 50%. Impact per respondent facility ranged from zero dollars to $19.1 million. Impact by two consulting firms, Nachimsom Advisors and KPMG were confirmed with the eleven respondents study. The complexities associated with obtaining impact dollars surrounding payor readiness, clinical documentation, ICD-10 code assignment and computer system readiness attributed to the disparity. Training physicians was their greatest challenge in tandem with clinical documentation as their greatest financial impact of $36.6 million or $6.1 million per facility, confirming industry estimates. Total impact for all categories was $17 million, compared to Nachimsom and KPMG respectively, at $8 million and $15 million. Key success factors; an implementation plan that includes payor testing, coder and physician education, clinical documentation improvements, end-to-end testing, denials management and a contingency plan, will mitigate the financial impact.

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