HRAA's Industry Pulse: One Year from ICD-10 Transition, Small- and Mid-Sized Hospitals Increased Staff Training Programs but Lag in Payer Preparations, Financial Modeling and Denial Strategies


Plantation, FL, Oct. 1, 2013 (GLOBE NEWSWIRE) -- A recent survey of 200 hospital administrators, hospital health information professionals and compliance employees conducted by Health Revenue Assurance Holdings Inc. (OTCQB: HRAA), a leading provider of technology and revenue integrity solutions for healthcare organizations, found that exactly one year out from the transition, more hospitals are taking steps to prepare for the implementation of ICD-9 to ICD-10.

While the results showed that hospitals are focusing on employee training, the survey also revealed that they are leaving their organizations exposed to massive claims denials when the transition takes effect. This is because they do not understand what ICD-10 codes will be accepted by the payers as it relates to reimbursement maps and diagnosis-related group (DRG) groupings. Additionally, they are lacking denial strategies and financial models to help them avoid what could be a colossal claims backlog post-transition.

"The good news is that hospitals have jumpstarted their training and documentation improvement. The not-so-good news is that they are not putting enough resources against understanding how their payers will operate once the ICD-10 transition takes place," said Andrea Clark, chairman and chief executive officer of HRAA. "This change is a massive shift in the healthcare system and it is vital that hospitals are compliant and ready on October 1, 2014."

The survey is a follow up to industry research conducted by HRAA in April 2013 which revealed more than half of hospitals were not complying with Centers for Medicare and Medicaid Services (CMS) suggestions and were falling behind the curve.

Hospitals Show Increase in Training Staff for ICD-10:

Of the hospitals surveyed:

  • 78 percent have begun ICD-10 CM training for coding staff, compared to last quarter's 60 percent;
  • 64 percent have begun ICD-10 PCS training for coding staff, compared to last quarter's 45 percent;
  • 68 percent have begun document improvement education for medical staff, compared to last quarter's 53 percent;
  • 76 percent plan to dual code prior to October 1, 2014, compared to last quarter's 69 percent.

"It is clear that ICD-10 is happening, and significantly more hospitals have begun programs since April" said Clark. "This is vital as coder productivity is expected to decrease by more than 70 percent with the transition. The better trained a hospital's staff is the more of a chance they can beat these estimates."

Payer Preparations Still Need Improvement:

While 71 percent of hospitals plan to submit ICD-10 coded claims to payers prior to October 1, 2014, they are not taking the initiative to understand how their payers are mapping their claims, which leaves them vulnerable to excessive denials and a slowdown in reimbursements.

85 percent stated that they DO NOT know if their payers are planning to map claims utilizing CMS reimbursement maps to group the claims to DRGs. Internally, less than half (42 percent) stated that they plan to use CMS reimbursement maps to evaluate DRG groupings compared to those based on the ICD-10 grouper.

"The survey data shows that while hospitals are focused on testing and preparing internally, they are not focused on mapping and the financial impact of the transition," said Ms. Clark. "We are encouraging our clients not to make assumptions but to implement technology and analytics to do the financial modeling and denial strategies now, so that they won't be playing a guessing game with their payers once the transition takes place."

To see a summary infographic developed by HRAA, please click here.

About HRAA

HRAA (OTCQB: HRAA) interprets data to ensure that healthcare is efficient and effective for everyone by pulling medical data together to create a predictive window to understand cost and revenues looking back and going forward. Founded in 2001 and based out of Plantation, FL, HRAA combines years of industry expertise with best-in-breed technology to create market leading business intelligence products and consulting services to ensure hospitals are reimbursed for every pill they prescribe, every procedure they perform and every test they administer. HRAA both trains and supplies the high tech workforce to hospitals to generate the predictive data used by the whole healthcare system and offers a full suite of solutions needed to keep up with the ever-changing healthcare industry including data analytics software, business intelligence technology, medical coding, auditing, education, revenue cycle consulting, and ICD-10 transition solutions. For more information please visit:

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CONTACT: Media Contacts: Danielle DeVoren / Taylor McGrann KCSA Strategic Communications 212-896-1272 / 212-896-1253 /

Source:Health Revenue Assurance Associates, Inc.