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CODING

4 steps to take now so your practice is ready for ICD-10

By Judy Monestime  bio

Now that the Centers for Medicare & Medicaid Services (CMS) has confirmed October 1, 2015 as the go-live date for ICD-10, providers must focus on making their ICD-10 implementation strategy a top priority.

The vast majority of healthcare providers expect to encounter a wide range of barriers to the ICD-10 implementation within the first six months of the compliance deadline, which will prevent them from fully realizing the potential benefits until the second quarter of 2016. Therefore, planning and budgeting for all aspects of the conversion process in order to diminish the economic and operational impact is paramount.

In an effort to ensure that your practice will be ready in time, here are best practices to assure key operational milestones are achieved and maintained during the remaining months of your ICD-10 preparatory journey.

• Assess ICD-10 training needs

Training will be one of the critical areas impacted by the adoption of ICD-10. Validate and re-assess scale and scope, and customize the educational plan to meet the needs of a diverse workforce during and following the transition. Place emphasis on “role based training,” as opposed to one size fits all solution. Healthcare practices will need to work with a vendor that will classify the roles into different subgroups. There must be consensus as to the extent of training that needs to be done, who (what roles) needs to be trained, what level of training is needed, and how training will be delivered. Different levels of training will need to be based on the impact of ICD-10 on roles and functions.

• Conduct clinical documentation readiness

Establish a clinical documentation program, internal communications operations, and physician champions to train and engage the organization’s medical staff in ICD-10. Perform a code level analysis on the selected 50 records of those ICD-9-CM codes that have more than one possible ICD-10 code to assess the accuracy of ICD-10 code and the accuracy of clinical documentation to support the specificity of the potential ICD-10 codes.

• Assess vendor & payer readiness

In the review of previous CMS regulatory initiatives, for example, v5010, there has never been 100% compliance. Your organization should consider the following steps:

  • Create an inventory of your external trading partners, sorting by annual dollar volume (high to low)
  • Reach out to your trading partners and schedule a test of healthcare transactions (837 and 835 transactions) using claims with ICD-10 codes.
  • Act appropriately to insulate your organization by preparing for dual processing and dual coding contingency strategies.

• Conduct ICD-10 testing

It is recommended that providers plan several phases and levels of testing for ICD-10 prior to implementation, and verify the accuracy in documentation and coding in order to ensure payment of claims. Before you begin testing, identify testing workflows and scenarios for your practice that apply use cases, test cases, test reports, and test data. Identify when your practice will be able to run test claims using ICD-10.

Payers are critical to the financial viability of the practice. Denials or payment delays may result in a substantial decline in revenues or cash flow. Payers may struggle with the ICD-10 transition due to the significant system changes needed to support policies, benefit/coverage rules, risk analysis, operations, and other critical business functions impacted by this change. Payer testing should identify and resolve any issues prior to go-live.

There are significant consequences of poor preparation for the transition. Providers depend on smooth processing of claims for cash flow, so it is important to devote full attention to preparation. Potential consequences include denials, processing delays, backlogs, and so on. The good news is that these problems can be mitigated with proper advance preparation.

References

Archer, Anita & Monestime, Judy (2013, September 17). ICD-10 Documentation for State Medicaid Agencies (SMA) Health Conditions Categories. HIMSS. Retrieved from http://www.himss.org

Letourneau, Rene (2013, December 16). ICD-10: Minimizing the Financial Hit. HealthLeaders Media. Retrieved from http://www.healthleadersmedia.com/

Managing external risks associated with the ICD-10 transition. Health Management Technology. Retrieved from http://www.healthmgttech.com/

Stewart, Elizabeth & Carr, Kim. Dual Coding: Show Me the Money! ICD10monitior. Retrieved from http://icd10monitor.com/

Judy Monestime, MBA, CDIP, CPC, is an AHIMA-approved ICD-10-CM/PCS trainer.

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