Medical Billing Lessons Learned from Other Countries

Canada changed over from ICD-9 codes to ICD-10 codes starting in 2001.

The bad news is the implementation did not go smoothly. The good news is we can learn from the mistakes their providers made.

ICD10Watch recently outlined eight lessons practice managers may want to incorporate into their changeover plans.

1. Forget about crosswalks. Gillian Price, now with QuadraMed, was an ICD-10 consultant during the transition. She  warns that the new codes are too different for crosswalks and mapping to work and recommends focusing on native ICD-10 coding.
2. Prepare for productivity to drop and stay down. Price suggests planning for a permanent drop in productivity. She advises focusing on boosting productivity now using automation so your practice can handle the coming downturn.
3. Realize that delays and cost overruns are inevitable. There will be delay-causing issues, says Price. Start your project now to leave yourself enough time, and add another 25% to your budget.
4. Understand the documentation issue. Doctors receive almost no documentation training in medical school, so this must be a key focus area.
5. Help doctors understand the scope. This is not an IT project, nor is it a billing project. Everyone must get on board for the changeover, and if physicians understand their role, they can be helpful in championing the necessary changes to their colleagues.
6. Give coders time to learn. In addition to formal training sessions, coders need time to get comfortable with the new system. Price says that once medical billing coders were comfortable with ICD-10, they were more energized and professional, using critical thinking skills instead of memorization to do their jobs.
7. Share information. Price believes Canada’s collaborative culture was a key part of smoothing out the transition. The US can moderate its learning curve by getting the word out about what works and what doesn’t.
8. Remember the benefits. Because physicians learned about disease and treatment from the data gathered using the new codes, patient care improved in Canada following the transition.

In reading about the Canadian experience, underestimation seems to be the most serious risk. When practices accept that their entire office will be affected, not just IT or the billing department, they take a giant step in the right direction.

What the land down under did right.

Australia initially started using ICD-10 to report mortality data back in 1994. The Australian Health Center took extensive steps to properly evaluate ICD-10 before the country started implementing it. Based off their research, this was their conclusion:

1. The sustainability and coding detail made ICD-10 better than ICD-9 and the switch as carried out as soon as possible.
2. In their interest to create an Australian modification system to ensure that the codes would be aligned with Australian diagnosis groups
3. Appointed a national coordination of ICD-10 implementation who met with territory coordinators to ensure implementation was not a difficult process.
4. High initiative to introduce educational courses through marketing materials and individual courses.

While both countries implemented ICD-10 in different ways, practices have a lot to learn from both countries. Lessons with a grain of salt. It’ll also  be interesting to see how whether these countries are able to implement future ICD changes similarly or differently.