According to CMS, 1 in 5 physician practices will see their Medicare denials double for up to 6 months after October 1, 2014, the deadline for ICD-10. Your practice does not have to be one of them. Get started early with planning for ICD-10.
The quick answer behind why the change from ICD-9 to ICD-10 is to improve clinical communication. The change will allow for better data capture relating to signs, symptoms, risk factors, and comorbidities. The specificity that ICD-9 lacks will be replaced with the ICD-10 code sets so that clinical documentation can better reflect the changes and advances in technology. Denials will no longer be a matter of clarification that can be handled by the billing manager. Denials after ICD-10 will raise questions about medical necessity and/or the clarity of medical documentation.
So, how will ICD-10 affect my practice?
The change to ICD-10 will affect more than just your coding department and should not be misjudged. There will be a significant change for anyone that captures diagnosis codes, including your clinical and administrative staff. A deeper knowledge of anatomy and physiology will be a huge help when it comes to the specificity of ICD-10 codes.
The risks of not being prepared for ICD-10 should first be identified in order to develop and execute a plan for your practice. Some of the major risks for the changeover include:
- Insufficient Training
- Lack of Preparation by EHR Vendors
- Financial Risks Associated with the High Transition Costs
- Reduction in Provider and Staff Productivity
Where should you begin if you haven't already?
- Identify your current work processes that use ICD-9 codes
- Talk to your EHR vendor about their plans for ICD-10
- Discuss the implementation plans with all key players to ensure a smooth transition: clearinghouse, billing services, and payers.
- Talk with the payers about how ICD-10 implementation might affect your contracts. Will your payment schedules be altered bases on code specificity?
- From your earlier evaluation on what uses ICD-9 codes, what changes to your workflows and processes need to change?
- Assess staff for training needs. Different staff will require different training based on their involvement with the diagnosis coding.
- Test ICD-10 transactions with your clearinghouse and payers.
- Budget for time and costs related to implementation, including expenses for system changes, resource materials, and training.
- Create a timeline for your ICD-10 transition that is realistic. Do not wait until the last minute or even last couple of months to do this.
With proper preparation you should actually be able to improve your reimbursements when ICD-10 begins, but it will take some time and effort on your part. Be proactive and invest in training for your entire staff. Set goals! And if those are not being met, seek help and resources.