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You Can't Opt Out of ICD-10

by Carey Manning, Product Marketing Manager

In a recent survey* of health care providers, 82% said they would have been “not prepared at all” or only “somewhat prepared” for ICD-10 had the deadline remained on October 1, 2014. This is understandable given all the burden practices and medical groups have to bear; however, that doesn’t negate the fact that preparation for ICD-10 must start far in advance of the deadline – and that holds true for the new 2015 date.

For many of the reasons laid out by Dan Haley, athenahealth VP of Government Affairs, we believe there are no benefits to delaying preparation for the new October 1, 2015 deadline. In fact, because ICD-10 directly impacts your cash flow, focusing on a smooth transition at your organizations should be front of mind beginning now. To ensure you’re nowhere near the “somewhat prepared” category come fall, we’re offering a series of ICD-10 blog posts to guide you through the preparation process. To begin, here are a few actions we encourage you to address right out of the gate:

Complete an ICD-10 Impact Assessment
It’s important to identify every part of your workflow that ICD-10 will impact. For most medical practices, this is likely to include updating and integrating systems, initiating change management for staff, clinicians, and billers and coders, and taking inventory of diagnosis-specific workflows or documents. After you’ve noted all the points of impact, you can identify the most significant transition bottlenecks and prioritize your planning efforts with a focus on these tasks.

Another key piece of this assessment is to understand how ICD-10 will impact your most commonly used diagnosis codes. Proactive vendors will have tools and resources to help you complete this assessment, test with interface partners, and determine the level of impact for those codes used most frequently today.

Determine training needs
Gauge your organization’s need for professional training – this includes brushing up on clinical documentation, anatomy, physiology, and ICD-10 coding nuances specific to the codes used in your specialty and practice. Since ICD-10 impacts every aspect of the patient workflow, training at some level should be evaluated for each role across your organization.

A great way to minimize productivity loss is to engage in ongoing learning right up to the compliance date, by practice coding on real patient data. Ask your health IT vendor about tools they may have that enable your billers and providers to practice ICD-10 coding now, so they can be more efficient when the compliance date arrives.

Create a comprehensive ICD-10 plan 
If you started planning for last year’s deadline, but then shifted focus to other initiatives, it’s time to dust off your ICD-10 assessment from last year. Review and update those plans, as certain items may have changed, such as new dates for payer testing opportunities or employees that need ICD-10 training or a refresher. If your practice is taking on ICD-10 planning for the first time, you can get started on the right foot this year. Be sure you understand the different components of a successful plan, and the resources and budget dollars required. You can find more information on the financial impact of ICD-10 in our ICD-10 Knowledge Hub.

Know your vendors and partners
If you had vendors that weren’t ready for ICD-10 last year, you should inquire with them now to see when upgrades will be ready. That way, you can plan training and testing engagements. Don’t know what to ask? I recommend my colleague Jennifer Bale’s post, “ICD-10 Transition: What to Expect from Vendors.”

  • Testing with payers: You should find out if your vendors will be coordinating and performing payer testing on your behalf. End–to-end testing is an important component to ensure that you will receive payment when ICD-10 is fully implemented. If your vendors aren’t testing with payers, you’ll need to research testing opportunities with your top payers and get on their schedules.
  • Coordinating for shared diagnosis codes: If your systems will be sharing diagnosis codes with other partners – labs, EHRs, billing systems – the ICD-10 version of these systems will need coordinated testing to ensure they will work together after the transition date to successfully transmit both the ICD-9 and ICD-10 code sets.
  • Knowing your software: Understand how your vendor’s software will help you arrive at a relevant, billable ICD-10 code. With the five-fold increase in ambulatory codes, your EHR should have diagnosis tools that serve up the most relevant diagnosis by using clinical terminology rather than force you to search through codes that require additional specificity in ICD-10. Productivity is key in determining which tools are right for your practice – and not all EHRs are the same.

Start preparing for a range of payer compliance
Although there’s an extra year to prepare, that doesn’t mean all payers will be ready. Practices should prepare for those who won’t be ready at the compliance date. As we have seen with previous government mandates like NPI and ANSI 5010, not everyone makes the deadline. You’ll need to be prepared for that reality to minimize payment disruption. Consider which payers and clearinghouses won’t be ICD-10 ready and how to best manage a “bilingual” environment after October 1, 2015.

It’s not just poorly prepared payers who’ll still be operating in ICD-9 at compliance date; some, such as workers compensation payers, aren’t required to comply with ICD-10. Proactive monitoring and adjusting 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, you’ll need flexible coding techniques to close out encounters and claims dated prior to October 1, when ICD-10 was not yet in effect.

If you haven’t started preparing, you’re not alone. In the aforementioned survey, only 56% of physicians said they had started ICD-10 preparation. The reality is that ICD-10 is one of the biggest changes that will ever impact your practice and there is no opt-out button. Those with a firm plan in place now will be well-positioned to make the switch with minimal disruption and a maintained focus on delivering care.

*athenahealth survey of more than 600 health care providers on Epocrates. 

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Comments

Submitted by claudia lucaire - Monday, October 26, 2015

Many of my providers are saying that since they are specialists, they have not had to change all that much and that the primary care doctors are the ones who have to worry....what would you say about that?

Submitted by Jay Keene - Monday, October 26, 2015

56% may say they have started but I afraid very few are really prepared.

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