AHIMA Chief: 'Hospitals are Ready' for ICD-10

Lynne Thomas Gordon, CEO of the American Health Information Management Association, says high turnout at the organization's annual conference is an indication that hospitals feel "pretty confident we're ready to go. If not, I don't think we'd have anybody here."

Will ICD-10 be the Big Easy?

This week, all eyes are on New Orleans, where the American Health Information Management Association has gathered for its annual convention. The event will conclude mere hours before the cutover from ICD-9 to ICD-10 for hospitals—and the one-year grace period for physician practices to adjust to the new coding system.

On Tuesday I spoke briefly with AHIMA CEO Lynne Thomas Gordon here in New Orleans about the transition to ICD-10. The transcript below has been edited for clarity.

HLM: Do you think that we'll know early on if CMS is processing ICD-10 claims correctly? How much of a concern is it to you that we won't know on October 1 how things are going? I wasn't reassured by the CMS press call last week. What's your thought on how responsive it can be in letting us know things are going all right with ICD-10?

Gordon: Great question. You're going to start coding when the bill drops. So you've got patients in the hospital and you're only going to start coding those patients that are discharged after October 1. Your bills are going to go in, and then I think you'll first know if you first start getting rejections, if you get denials, unless something just catastrophic happens, and course they've done the testing.

CMS: No ICD-10 Audit Claims for Specificity in Year One

They feel things are good to go. So the quickest way [to know [if there are problems] is, if I were a hospital, I'd send in my bill, and I'd start getting rejections, rejections, rejections, and problems. That would be my first red alert. Of course, most hospitals are going to know their typical rejection rate. What do we send in? How does it come back? So that will be the first red flag.

HLM: And how long do you think it will take before we start to know if that is even a big problem?

Gordon: I don't know the exact answer. I am thinking it's going to be 30 days. It would depend on how long it takes them to adjudicate and get it back out, and I don't know how fast they are. I hate to say the government takes 30 days, because I don't know the real answer to that.

HLM: When you're working on a slim cash margin, like many providers are, 30 days can be an eternity—a long time to know you've got a problem.

Gordon: I think it depends on the provider, too. How clean are their claims going in in the first place? What's their track record? Are they getting things through normally with ICD-9? I used to work in revenue cycle, and on the back end, you're always looking at why did this get rejected, what happened here? You're looking for different things, not just the ICD-10 code.

HLM: It's not always as simple as yes or no.

Gordon: Exactly.

HLM: Some people are worried that certain payers will find [the ICD-10 implementation] a convenient excuse to delay payment. Have you heard that?

Gordon: I think hospitals think that all the time. It's just one of the things they always say. It could be possible. I'd like to be optimistic and think that people are trying to be fair and square. The problem is, if they do that, they're just chasing things down the road.

I would think, if I were a payer, I would want to make sure things were working well before I used [ICD-10] as a delay tactic. We've got this big change, and we've got to make sure we've got our act together before we start doing shenanigans.

HLM: How would you even prove the shenanigans anyway?

Gordon: You wouldn't. I will say, if you are a well-run organization, you do have benchmarks. You're looking at your A/R all the time. You're looking at your denial rate. You're looking at your coding quality. You're looking at your coding productivity. You have an eye on the ball.

So when something goes askew, you're going to know it, and people are going to be even more fanatical than usual, because they're going to be going, 'okay, this is a change.' So if we have been looking at our metrics closely before, we're going to be especially careful to be analyzing what's coming back in, [and] how are things going out.

I think hospitals are going to be on high alert to say, 'we don't want to have any cash flow problems, so we're going to make sure we're doing everything on our end.'

I have to say, we've got a great turnout at the convention. That tells me hospitals are ready. They feel pretty confident we're ready to go. If not, I don't think we'd have anybody here. I think it says a lot for the healthcare industry.

HLM: I'm impressed by the longer-term vision of this HIM community, which is how coordinated care happens, and how the coordination with long-term care happens. This is a vital component of health IT that doesn't always get the credit it deserves, but boy is it important.

Gordon: We used to be able to really manage the patient's story. We could make sure it was trusted. We could make sure it had integrity when it was on paper.

Now that we've put in all these electronic health systems, what we're saying is, you have got to have information governance. You have got to make sure that you've got principles in place and framework and people that are being held accountable.

We feel like we're the water that flows through the pipes, and IT, they're the pipe. And you don't want your water corrupted. You want it to be safe. You want it to be secure. You want it to be there on time.

That's our job.

People just assume their information is correct. What they don't realize is there is a whole profession that's out to make sure that we're taking care of the patient's story and can be trusted. Our members are very technical and very well-trained. It is hard to explain to people what we do. We believe strongly that not only does it help patient care, but we also believe it helps with patient safety. We've been in discussions with the Joint Commission, and they get it big time.

HealthLeaders Media Webcast: How Health Systems Prep for ICD-10—Physician Alignment, Support and Technology, will be broadcast on Tuesday, October 20, 2015, from 1:00 to 2:00 p.m. ET. Hear from the University of Mississippi Medical Center's chief health information officer as he describes how to overcome the obstacles of implementing ICD-10.