In just a few months the new ICD-10 diagnostic codes will officially take effect and physicians will be required to be 100% compliant or risk not getting reimbursed. These changes to medical billing practices are expected to cause major disruptions to practices’ revenue flow.
So what are healthcare providers to do? How can physicians and their staff become comfortable with 149,000 new codes when they’ve only had to deal with 17,000 in the past? Sure these additional codes will allow for greater detail and classification of diagnosis and more, but they will also, at least at the outset, cause confusion among in-house billers and numerous claims to be denied. And no small practice can afford to have any claims denied.
With this in mind, here are some ways providers and their staff can prepare themselves for the ICD-10 transition:
As a provider, the first thing to understand is that there will be an intense need for increased specificity within documentation once ICD-10 is in place. You and your staff will need proper training to learn how to adjust your documentation so that it meets these new requirements. You will most likely also need training on any systems changes, especially if you have recently switched EHR systems.
You will also need to do the following:
- Identify all current work processes that are using the old ICD-9 codes. These will be things like encounter forms and superbills, clinical documentation, EHR systems and practice management systems, quality reporting protocols, and contracts.
- Create a cheat sheet with all of your most used codes if you have to.
- Speak with your current practice management system vendor to see if your contract includes upgrades as far as your agreement. And, if you don’t currently have a vendor but are shopping for one, be sure to ask if they are ICD-10 ready.
- You’ll next want to be in touch with all of your clearinghouses, payers and billing services to discuss implementation plans and set a date to test the systems.
- Determine how much training your staff will need and specifically identify the office staff who are responsible for coding so you can focus on staff that needs the training the most.
- Make sure you’ve budgeted for all of the time and costs related to the ICD-10 transition. This should include things like expenses for training, software updates and system changes.
Coding and billing staff will be responsible for evaluating a much larger code set. Billers must understand all of the new payer policies under ICD-10 and the entire billing department will need to be trained on these policies as well as any new procedures (think new appeals process), of which there’ll be many.
Billers will also have to:
- Become familiar with all system upgrades.
- Identify the current ICD-10 codes used the most and put them in order of frequency.
- Once identified, make sure current documentation supports them.
- Learn the new codes most relevant to your provider as well as the specific anatomical relationship each represents.
- Once you’ve completed this process for the most frequently used codes, move on to other specialized codes that pertain to clientele that will also be a part of your daily routine.
- Notify the practitioner of the specific documentation that’s missing from current patient records.
- Perform a few test transactions with payers and clearinghouses using the new ICD-10 codes. Check to see when they will begin testing and which days they have those tests scheduled.
- Learn to fully understand how money is working in your practice so once ICD-10 has been implemented you’ll know if it’s causing any problems. You’ll specifically want to evaluate your payer mix, determine what’s typical for your accounts receivable cycle, and examine your denied claims.
It’s also a great idea to work with your billing software vendor to make sure that the ICD-10 codes you are most likely to use immediately upon transition have been plugged into the software.
It’s as important to work with your vendor during this time as it is to do all of the preparation on your end. Make sure they will be able to meet your new requirements and are willing to give you all planned updates and transition dates in writing.
Not only do practice managers have to oversee these ICD-10 implementations across all other departments, they will also be responsible for revising any policy or procedure associated with tracking, disease management, or diagnosis codes. They will also need to make sure that all payer and vendor contracts are evaluated and updated, and that budgets have been created to reflect the need for new contracts, paperwork and software changes.
It is the practice manager who will need to come up with a training plan since everyone on staff will need a certain amount of training that is the most relevant to their role. They will also need to consider the best medium for training, ie, online training VS in person training VS on-site training.
And finally, practice managers must be in charge of ensuring there is strong and clear communication between all departments. Even with extensive training and support, to err is human and mistakes will no doubt occur without effective and open channels of communication.
There is no indication that the ICD-10 deadline will once again be extended, so better to be prepared than hope for a miracle. Now is the time to gather staff and analyze how these significant changes will affect your practice and determine how best to prepare for them. If you haven’t done so already, get your staff trained and recognize this training will be an ongoing process. Though the clock is ticking there is still some time left to prepare, and it is preparation that will protect your revenue and cash flow, which is no doubt your biggest concern right now.