The shift to ICD-10 is more than just a compliance exercise – it represents a monumental transformation for healthcare in America. Just how prepared are we?

According to a recent National Pilot Program Outcomes Report, professional coders were only able to achieve 63% accuracy when submitting ICD-10 codes.

The transition to ICD-10 virtually impacts every member of the healthcare continuum including providers, payers and health IT vendors. Amongst these, providers have the most to lose. If claims are not submitted correctly, providers will not be paid and with just a few months until ICD-10 comes into effect on October 1, 2014, a provider’s ultimate goal should only be planning and training.

Why so complicated?

ICD-10 greatly increases the specificity of diagnostic codes. The number of outpatient diagnostic codes will increase by almost 44,000 – a fivefold addition.

For healthcare organizations, shifting to the new system will require training for coders, billers, and providers in the documentation requirements, as well as changes to existing billing software or potentially upgrading it.

Experts recommend practices to secure a line of credit ahead of the transition that they can draw on, as the transition to ICD-10 is expected to affect cash flows temporarily.

Seize the opportunity

Providers need to accept ICD-10 as an opportunity to ensure better care with more elaborate documentation, rather than get frustrated by the large number of codes. Their Electronic Health Records (EHR) solution should have the capability of allowing them to create lists of their most frequently used diagnoses codes to help them document conditions along with the co-morbidities rapidly and properly.

Boosting reimbursements

Since it will be easier for practices to document co-morbidities, ICD-10 has the potential to boost overall reimbursements. However, practices that do not document properly may see a 1-4% reduction in reimbursements under the new coding system.

One way to reduce the financial impact of the transition is to have an external chart reviewer analyze your documentation process now and determine what changes you may need to ensure compliance with ICD-10. This can be done with just 10 to 50 charts that represent a large proportion of your patient volume. Ideally these charges should be high-value and more likely to be denied.

Name a point person

An important first step is to name a “point person” to lead the transition. The practice manager or chief coder may be the ideal person for this job.

Work with your health IT vendor

Start by contacting your software vendors to learn about their plans for ICD-10 upgrades.

EHR vendors are aware of the conversion deadline and should already be working to update their software to conform to ICD-10. The need for timely communication between vendors and practices is pivotal.

Implementation cost

Most researchers suggest the implementation cost for small (one to two providers) to medium (five to ten providers) practices will range from $80,000 to $300,000 based on their requirements. For larger practices with a hundreds of providers and support staff, this cost can go up to $3 million.

Training

There are many options available for staff training, but vendors are the best place to start. Practices should consider sending an experienced coder for specialized training, while other staff members can get up to speed with less-expensive online resources. The amount of training providers may require can depend on how they select their codes.

It is also advisable to have your coders take refresher courses in anatomy and physiology relevant to your practice, because ICD-10 requires more precision and specificity.

If you outsource coding, ask your vendor about ICD-10 readiness and insist on more than blanket reassurances of ICD-10 compliance.

Finally, start testing

The only way to know if you are ready is to run some tests with ICD-10 data. You can submit test claims now if the clearinghouse or payer(s) participates. Double coding a small subset of your charts now will show you where your problems are.

The sooner you can start testing the better, so you can identify issues and start fixing them or develop contingency plans to be fully prepared in time.

 

ICD-10