November 13, 2013|Categories: ICD–10
We are now less than one year away from the transition to the ICD-10 code set. Realistically, there’s not much buffer left to create transition plans, so the decisions practices make now will determine their ICD-10 success in October 2014.
Throughout the next year, I will provide quarterly updates on specific best practices, training or tips that should be helpful during that particular time in the transition process. Based on what we’re seeing in the industry across providers, plans, payers, vendors and the government, we’ve identified five critical areas that all practices should address this quarter:
- Planning should be well underway
At this point, you should have a well-defined approach to the ICD-10 transition. Start by identifying the most significant transition bottlenecks that your practice faces and prioritize your planning efforts with a focus on these tasks. For most practices, this is likely to include updating and integrating systems; initiating change management for staff, clinicians, and billers/coders; and taking inventory of diagnosis-specific workflows or documents.
- Prepare for a range of payer compliance
Not all payers are required to comply with ICD-10 guidance, so providers need to think about which payers and clearinghouses won’t be ICD-10 ready, how to best manage a “bilingual” environment, and how doing so will affect operations. (See our previous post on particular payers I’m referring to.)
Practices should also be prepared for payers who are late to the ICD-10 transition, or are experiencing problems; proactive monitoring and adjustments will be essential in order to maintain cash flow. Lastly, remember that the transition date is based on the ”Date of Service;” once the transition begins, this will require flexible coding techniques to close out encounters and claims that are dated prior to 10/1/2014.
- Ensure that your vendors and systems will work together
Make sure that your vendors have held coordination meetings, and established their solutions for interfaces, reporting, and diagnosis-related data storage. Practices should emphasize the implementation of systems that can exchange ICD-10 codes, ICD-9 codes, and both sets of codes at the same time. Systems will also need to work together after the transition date to manage and report on both code sets. For a full list of questions you should be asking your vendor(s), I recommend my colleague Jennifer Bale’s post, “ICD-10 Transition: What to Expect from Vendors.”
- Get ready to provide more granular information for coding
Solutions that help you arrive at a relevant, billable ICD-10 code can help reduce your work. Evaluating tools you can use to search and select diagnosis codes will aid in preparing for ICD-10, as you are likely to use them more frequently during the ICD-10 transition. Ease of use, of course, is key in determining the tools that are right for your practice. You should also gauge your practice’s need for professional training, including brushing up on clinical documentation, anatomy, physiology, and coding nuances of ICD-10, specific to the codes used in your specialty and practice.
- Don’t count on any delays!
All signs point to the compliance date sticking. The Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) have both reiterated that the transition date will remain October 1, 2014. Practices should prepare to be flexible, and make scenario plans to accommodate any potential late changes to the regulation. Once again, this kind of adaptability in your operations will help mitigate the risk of further turbulence caused by future industry changes.
Practices with firm plans that account for these five points are on their way to a successful ICD-10 transition. Tackling the technology and change-management challenges will be an industry-wide effort; if your organization can already accommodate a range of outcomes across your business and care delivery partners, you’ll be well-positioned to make the switch with minimal disruption and a maintained focus on delivering care.
Check back in early 2014 for my next ICD-10 update and, as always, follow the ICD-10 category on our blog for additional ICD-10 content.
We invite you to learn more with our on-demand ICD-10 webinar, available at your convenience.