The transition to ICD-10 is now only months away. Practices that have not started preparing need to get started immediately because switching from 14,000 codes under ICD-9 to more than 68,000 codes under ICD-10 will be a major transition, even if the practice bills only a fraction of the new codes.
The good news is that clinical and administrative staff can be ready for the deadline with effective practice-wide training, pre-implementation testing and deployment of cost-effective IT tools. And, while challenging, the ICD-10 transition will help prepare your practice for more than just a new billing requirement. This shift will help you become more adept at electronically capturing detailed clinical data at the point of care, analyzing the data for accuracy and quality markers and communicating collaboratively with payers.
All of these processes will help equip your practice with the skills for the shifting payment models that reimburse for care quality performance and cost control instead of volume of services.
For the time being, however, your practice’s ICD-10 transition preparation needs to address these key areas:
1. Training. ICD-10 training for physicians is essential. The limited time left before the enforcement deadline in October means training must be highly targeted to the practice’s specialty. There are 21 chapters in the ICD-10 manual, so concentrating on the chapters with the diagnosis codes the practice encounters most often is recommended. A report of the practice’s most frequent diagnoses should be easily generated from the practice management system.
Too often, however, practices neglect to adequately train their coding and/or billing staff and instead devote the bulk of their educational resources to providers. While it may be an additional expense, training coders for the ICD-10 transition will be an investment that pays off after October 1 in terms of maximizing the practice’s productivity during implementation as well as reducing claims rejections and backlogs of unfiled claims.
2. Testing. Performing tests of your IT systems to ensure they are ready for the transition to ICD-10 should be occurring simultaneously with the provider and coder training. This is especially true for those IT systems that interface with payers and clearinghouses.
As an element of the testing preparation, create a “payer grid” that lists all of your practice’s largest health plans and their specific representatives, including their direct phone numbers and email addresses. Coordinate your pre-ICD 10 deadline testing with this contact person to determine that the health plan’s systems are ready to adjudicate claims with ICD-10 codes, or how long they expect to be using ICD-9. Quick online or electronic access to the payer’s policies and procedures is also helpful information to include on the grid.
Likewise, establish a payer liaison, such as the office or billing manager, who will be the practice’s designated ICD-10 expert and primary contact person for health plan transition updates.
3. Tools. For every practice size and budget, there are IT tools available to help with the transition. Encoders, for example, which assist with generating accurate ICD-10 codes, are available for as little as $400 a year. Similarly, online reference tools, such as icd9data.com, are available for free, but they lack integration with a practice’s IT systems.
Transition support can pay dividends
Even with all this preparation, the transition from ICD-9 to ICD-10 will be challenging. Coders’ productivity may be reduced 25 percent to as much as 60 percent. This impact, however, can be minimized with focused training for the entire practice, IT systems testing and deployment of the appropriate IT tools. Seeking counsel from an experienced advisor can also help the practice avoid costly mistakes and ensure that the training, testing and IT resources are wisely invested. Each passing day means there is less time to prepare, so practices need to get started now.
Arlene F. Baril, MHA, RHIA, CHC is senior director of reimbursement and advisory services for Altegra Health.