All Quiet on the Rural Healthcare Front?

No ICD-10 hiccups thus far

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Healthcare providers continue to forge ahead with ICD-10, and so far, no major problems have been reported. Even rural healthcare providers seemed to have weathered the storm for now. However, is it too soon to make assumptions about the impact of ICD-10 on rural health facilities and critical access hospitals? The National Organization of State Offices of Rural Health reports that "over the next six months, the needs of rural health providers will be better understood."

We spoke with three of our clients to better understand some of the ICD-10 challenges that are slowly emerging for rural health providers today, and what providers are watching for in the months ahead.

Coder shortages remain a concern
"There have been a few denials and delays from payers, but nothing that has been a game stopper for any of the CAHs," says Debra Primeau, CEO of Primeau Consulting Group, Inc. "One area I am hearing that is pervasive is the decreased coder productivity. Seems it is running about 25%-30% overall and is impacting the bill holds, which of course, will increase A/R and slow down payments. There just aren't enough coders to help with the backlogs. My concern will be with the impact this will have over the longer term for smaller facilities."

Year-end reporting causes headaches
According to one of our sources-an HIM director working in a 200-bed community hospital in Florida-ICD-10 has gone smoothly, and the organization has been paid exactly what it anticipated. "We were very prepared and it is paying off," she says. "The only surprise was with our reporting. We are now running 2015 reports, and there are two months of data with ICD-10 codes versus I-9 codes. So pulling together our rarely-used annual reports is our only current ICD-10 gotcha."

SEE ALSO: NCDs and LCDs Hit Hardest by ICD-10

Audit programs get refreshed
Finally, as I predicted in an earlier column, coding audit activity has increased. "There was an all-hands-on-deck approach to coding throughout most of 2015 for small hospitals," mentions Greg Goodale, Director of Business Analysis at TrustHCS. The added focus on clinical coding last year served to uncover many opportunities for organizational improvement. "Good things came from the extra focus and attention on coding."

Goodale finds that clients are continuing to monitor coding activities and moving towards concurrent, ongoing coding audit programs-versus once a quarter or annual reviews. In healthcare, new regulation typically has a ripple effect on operations and outcomes. "Many are still waiting for the other shoe to drop with ICD-10 and using coding audits as a light house beacon to help remain prepared," he concludes.

Watching for red flags and second shoes
As rural hospitals continue to submit ICD-10 claims and payers become more ICD-10 savvy, the volume of denials is expected to increase. Rejections and denials rates are being closely watched across healthcare-including rural health.

There are still many months ahead in 2016. Likewise, the physician grace period is still in effect. While we watch and wait, small providers are advised to monitor denials, conduct coding audits, and keep one open for rising red flags and dropping second shoes.

Also reach out to your state's hospital association, other active state rural health associations, and the National Rural Health Association to see whether they're offering any ICD-10 webinars, conferences, or newsletters. And be sure to check out the ICD-10 implementation toolkit offered by the National Rural Health Resource Center. The toolkit includes leadership tools, preparation checklists, impact diagrams, timelines, budget frameworks, and more.

Beth Friedman is the President of Agency Ten22. Prior to starting the firm in 2005 formerly known as The Friedman Marketing Group, Beth served as Director of Marketing for A4 Health Systems, McKesson, and eWebCoding. Beth holds a Bachelor's Degree in Healthcare Administration and is a registered health information technician (RHIT). She is a member of HIMSS, AHIMA, HFMA and the American Marketing Association. Beth began her career as a clinical coder and supervisor for two large Pittsburgh hospitals. From coding, she moved to quality assurance and data management before joining the vendor community in 1991.

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