By Mary Jean Sage, president and founder, The Sage Associates
The deadline for implementing ICD-10 is quickly approaching. Providers and practices should be preparing for the transition and approaching the implementation with confidence. Even though on July 6, 2015, CMS announced a one year grace period for ICD-10, it did not delay the implementation. Effective October 1, 2015, a valid ICD-10 code from the correct family will still be required on all claims. These 10 steps will help you prepare successfully for the transition.
While it may seem overwhelming, it is possible to smoothly make this transition by following the following 10 steps.
- Understand ICD-10
Review the major differences between ICD-9 and ICD-10 and how those differences will affect a clinician’s specialty as well as your organization as a whole. Reviewing the “Official Guidelines for Coding and Reporting” for ICD-10 is a good starting point.
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Create Your Internal Implementation And Communication Team
Include staff from administrative and clinical sides of your practice and divide up the work that needs to be accomplished. Make sure you communicate the changes required by ICD-10 both from a workflow standpoint as well as clinical documentation.
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By Mary Jean Sage, president and founder, The Sage Associates
The deadline for implementing ICD-10 is quickly approaching. Providers and practices should be preparing for the transition and approaching the implementation with confidence. Even though on July 6, 2015, CMS announced a one year grace period for ICD-10, it did not delay the implementation. Effective October 1, 2015, a valid ICD-10 code from the correct family will still be required on all claims. These 10 steps will help you prepare successfully for the transition.
- Understand ICD-10
Review the major differences between ICD-9 and ICD-10 and how those differences will affect a clinician’s specialty as well as your organization as a whole. Reviewing the “Official Guidelines for Coding and Reporting” for ICD-10 is a good starting point.
- Create Your Internal Implementation And Communication Team
Include staff from administrative and clinical sides of your practice and divide up the work that needs to be accomplished. Make sure you communicate the changes required by ICD-10 both from a workflow standpoint as well as clinical documentation.
- Review The Impact Areas Of Your Practice And Modify Processes
Consider all the different systems you use, what organizations you exchange data with, as well as what electronic and paper-based workflow processes you use that drive clinical encounters and the billing process. Make sure all of these are updated and/or modified appropriately for ICD-10 compatibility.
- Reach Out To Your Software Vendors
Ask about any needed upgrades to use ICD-10, what training (if any) will be needed, and cost estimates. Don’t forget to ask about the ability to concurrently use ICD-9 and ICD-10 and how long you’ll have the ability to do that.
- Develop Your Budget
Make sure you consider software and hardware upgrades; education and training costs; the cost of temporary staff during transition should it be needed; changes to printed materials; additional time for documentation review; and the cost of lost coder, clinical and/or revenue cycle staff productivity.
- Contact Your Clearinghouses And Health Plans
Ask when they will complete their upgrades to accommodate ICD-10, how will they help your practice with the transition, when can you test claims and other transitions with ICD-10 codes, and whether they provide a list of any data content changes needed. Don’t forget to ask the health plans when they expect to announce their revised ICD-10-related coverage/payment changes.
- Improve Clinical Documentation
This may be one of the most challenging aspects of ICD-10. Identify potential documentation issues by beginning to crosswalk ICD-9 codes to ICD-10 codes now. The goal should be to identify any gaps in the documentation that prevent a coder from selecting the appropriate ICD-10 code.
- Train Your Staff
Identify your education needs; while everyone will need to be trained, not everyone will need to be trained at the same level, so identify who should be trained on what. You will also need to identify the best training mode for each group and the timeframe for providing that training.
- Test Your Systems
Testing is critical to success with implementation. Plan for both internal testing, as well as external testing. This will need to be scheduled, so begin the planning now.
- Plan For Contingencies
Every practice needs to plan for decreased staff productivity and prepare for the possibilities of other financial challenges during the initial implementation period. You should set aside some cash reserves for the practice. It may also be wise to consider establishing a line of credit.
Preparing now for the transition to ICD-10 will help ease the burden of compliance on October 1, 2015 and assure you will not have a major disruption in your practice revenue.
About The Author
Mary Jean Sage is president and founder of The Sage Associates and expert consultant in billing and coding for the Cooperative of American Physicians, Inc. CAP offers a range of products and services, including medical professional liability protection and risk management services, in the health care field. The Sage Associates is a leading multispecialty provider of health care management services.
