Whether you're just starting out with an ICD-10 plan of action (hopefully not) or you have been preparing for years, it is easy to become overwhelmed and forget everything that a good ICD-10 plan entails.
With ICD-10 being just 10 months away, we wanted to cover some of the most important tips for a good ICD-10 plan. Check them out below to make sure your ICD-10 transition is successful.
Don’t underestimate 68,000 codes
While ICD-9 contained 14,000 diagnosis codes, ICD-10 is made up of 68,000 diagnosis codes. A recent survey conducted by AHIMA and the eHealth Initiative found in a recent survey that thirty-five percent of providers believe they will take a hit to their revenue cycle from the new code set. Eighteen percent are unsure of how ICD-10 will affect their billings. Whether you think your revenue cycle will or will not take a hit from ICD-10, it certainly is not something to take lightly.
Analyze your practice
Identify the changes that are going to happen in your practice’s workflow when ICD-10 arrives. Most affected processes will be documenting clinical records, creating e-superbills, and reporting measures. Analyzing how your practice handles these processes now and having a plan in place for the changes with ICD-10 will bring fewer surprises on October 1st to your staff.
Complete a financial impact assessment
If you have already completed an impact assessment but it happened before the first couple of delays, you may want to consider completing another. Many practices may have gone with different vendors and/or systems since the delay(s). Workflow, patient volume, and processes could have also undergone changes during the shift in timeline. 27% of providers still have not completed a financial impact assessment. If you are one of them, click here for information from CMS on an impact assessment.
Have a captain
Select a team member to oversee the ICD-10 process. This person will be the “go-to” resource for all things ICD-10. Having one person in charge of the preparation will help your practice stay organized and meet deadlines. The ICD-10 captain should be held responsible for creating a project plan that includes the goals, timelines, resources needed, and an overall idea of the impact ICD-10 will have on the practice.
Investigate your denials
“With ICD-10, it’s anticipated that days in accounts receivable may go up by 20 to 40 percent,” warns Summer Scott Humphreys, Executive Consultant for Beacon Partners. If you are already receiving a high volume of denials you will definitely want to investigate them to see what the root of the problem is. Denials are likely going to be even higher when ICD-10 arrives so it is imperative to have a strong revenue cycle team that can spend time fixing the existing denials. Focus on denials by provider, coder, payer, and figure out why they’re happening. Find out the source of the denial first. Claim denials are often caused from a registration error, lack of medical necessity, insurance verification not performed, charge entry error, documentation to support the claim is not there, etc. Measure your practice’s denial data and find out the source of the denial. Identify the top three to five reasons for your practice’s denials and take action. Less than 5 percent of claims should be denied on the first submission and your practice can make the necessary changes internally if denials are being caused due to practice errors. If payer errors are causing a high denial rate, you will need to make sure that your staff understands the payer’s reimbursement policies.
Educate all staff members
ICD-10 does depend heavily on technology but we can’t forget the importance of education. ICD-10 is going to affect the quality of documentation clinically and financially. Physicians need to be trained to produce better notes while coders need to have a strong understanding of anatomy and pathophysiology.
We also tend to forget that physicians and coders don’t always speak the same language. With ICD-10 coders and physicians will need to work together so there is a good understanding of what the coder needs and also why more specificity is needed. Conduct a documentation readiness assessment at the practice. Take a look at each physician’s current documentation and see if it can be coded with ICD-10. Besides conducting a documentation readiness assessment the practice can also run a frequency report of the most utilized codes by the physician. The coder will need to look at the documentation for those codes to see if the physician is giving enough documentation in order to select the code.
Question your vendors
Make sure your vendors (EHR vendor, billing services, etc.) are ready for ICD-10. Claims prior to October 1st will need to have ICD-9 codes attached while claims starting on October 1st will need ICD-10. Make sure your practice management software can handle both sets of codes and that the carriers can handle both sets of codes.
You can also review your contract with each vendor to see if updates are covered and if they provide help with the transition to ICD-10. If you are using a vendor for the medical coding and billing make sure your coders are Certified Professional Coders. Having a CPC to review the coding will make a big difference when ICD-10 is here.
If your vendor or clearinghouse is not going to be ready for ICD-10 you will need to seek other options. Create a list of vendors and clearinghouses that can help you and get started as soon as possible. October 1st will be here before you know it.
Test, Test, Test!
According to a recent survey by AHIMA and the eHealth Initiative, ten percent of organizations do not have a plan in place for conducting end-to-end testing, and 17% don’t have a clear idea when their organization will be ready to begin the lengthy and cumbersome testing process.
The longer you wait to test, the less time you have to fix errors. Complete internal and external testing. Internally you will need to test the new coding system inside the practice and determine if the staff is ready to apply ICD-10 codes accurately. Examine the number of claims that are processed with the new ICD-10 codes.
Also conduct external testing with payers and clearinghouses. If you have a payer or clearinghouse that’s able to test with you, test with them now. This will help you determine if your transaction partners are in sync with the changes.
Your practice can also sign up for ICD-10 acknowledgment testing. The Centers for Medicare & Medicaid Services (CMS) is offering ICD-10 acknowledgment testing weeks prior to the Oct. 1, 2015 ICD-10 compliance deadline. Providers will have two opportunities to participate in ICD-10 testing in 2015 (3/2–3/6 and 6/1–6/5).
Here are details from CMS about Participating:
How to participate:
Information is available on your MAC website or through your clearinghouse (if you use a clearinghouse to submit claims to Medicare). Any provider who submits claims electronically can participate in acknowledgement testing.
What you can expect during testing:
- Test claims with ICD-10 codes must be submitted with current dates of service (i.e. October 1, 2014 through November 17, 2014), since testing does not support future dated claims.
- Test claims will receive the 277CA or 999 acknowledgement as appropriate, to confirm that the claim was accepted or rejected in the system.
- Testing will not confirm claim payment or produce a remittance advice.
- MACs and CEDI will be staffed to handle increased call volume during this week.
Don’t be negative
Having a bad attitude about ICD-10 is only going to make the transition ten times worse. Having a positive and fun atmosphere for employees during this difficult transition will make each day more enjoyable for them. Because a bad attitude can spread, ICD-10 leaders will need to put forth additional effort to make sure that the preparation process for ICD-10 does not allow bad attitudes.
Convert to ICD-10 and monitor your productivity
After October 1st you will need to watch for denials. Be prepared to have prompt follow up of any denials. Providers will also need to keep up their communication with the coders to make sure their documentation is supporting the ICD-10 codes being used. If one person is responsible for the billing at your practice you may want to keep up with the reports and key performance indicators to measure performance. Sometimes smaller or even mid-size practices have been blinded by the performance of one person that is controlling all aspects of the revenue cycle management process. Having more than one person to oversee the billing process and reports will help you keep control of your revenue cycle.