By Mary Jean Sage
It has been a long time coming, but the ICD-10 implementation date is nearly here. While the Centers for Medicare & Medicaid Services (CMS) announced its intent to offer some flexibility to physicians and other healthcare providers for the 12-month period following implementation, ICD-10 code sets still need to be implemented beginning October 1, 2015.
By now, all providers and practices should be well into their preparation plans for the transition and in a position to implement the new codes with confidence.
Are you ready? Here are 10 steps you should take today to make sure your practice is prepared.
1) Review Impact Areas and Modify Processes
Pinpoint where and how diagnosis codes are used in your practice. Consider all the different systems you use, the organizations you exchange data with, as well as what electronic and paper-based workflow processes drive clinical encounters and your billing process. Make sure all of these are updated and/or modified appropriately for ICD-10 compatibility.
2) Build Your Internal Implementation and Communication Team
Include staff from the administrative and clinical sides of your practice, and divide up the work. Make sure you communicate the changes required by ICD-10, from both a workflow and clinical documentation standpoint.
3) Touch Base with Your Software Vendors
Ask vendors about any necessary upgrades to support ICD-10, what training (if any) will be needed, and cost estimates. Don’t forget to ask about the ability to concurrently use ICD-9 and ICD-10, and how long you’ll be able to do so. Also, ask about any crosswalk or translation programs that will be used as part of the software.
4) Create a Budget
Make sure you consider software and hardware upgrades, education and training costs, the cost of temporary staff during transition if needed, changes to printed materials, additional time for documentation review, and the cost of lost clinical and/or revenue cycle staff productivity.
5) Contact Your Clearinghouses and Health Plans
Ask if all of their upgrades to accommodate ICD-10 have been completed, and if they haven’t, when they will be finalized and available. Also ask how the clearinghouses and health plans will help your practice with the transition, when you can test claims and other transitions with new codes, and whether they plan to provide a list of any data content changes needed. Ask health plans when they expect to announce their revised ICD-10–related coverage/payment changes.
6) Get to Know ICD-10
Review the major differences between ICD-9 and ICD-10, and how those differences will affect your specialty as well as your organization as a whole. Reviewing the “Official Guidelines for Coding and Reporting for ICD-10” (http://go.cms.gov/1gF3ULC) is a good starting point.
7) Prepare Your Staff
Will all staff need to be trained at the same level? You will also need to identify the best training mode for each group and establish the time frame for providing such training. Don’t forget to allow for some post-implementation training once you have begun using ICD-10 codes.
8) Improve Clinical Documentation
Identify potential documentation issues by beginning to crosswalk ICD-9 codes to ICD-10 codes. Then, assess current documentation to see if it supports ICD-10 codes. The goal should be to identify any gaps that prevent a coder from selecting the appropriate ICD-10 code.
9) Test Your Systems
Plan for both internal and external testing. This will need to be scheduled with various vendors, so start now.
10) Prepare for Contingencies
Every practice should plan for decreased staff productivity and the possibilities of other financial challenges during the initial implementation period. Set aside some cash reserves for the practice, and consider establishing a line of credit.
Mary Jean Sage is president and founder of The Sage Associates and an expert consultant in billing and coding for the Cooperative of American Physicians Inc (CAP). She can be reached at PSPEditor@allied360.com.