October 1, 2013 marked the one year count down to the most profound change in health care since the new millennium. At present, all signs indicate that October 1, 2014 will remain the compliance date for the ICD-10 transition. Preparation and readiness are the keys, and it is important that all stakeholders are prepared and educated on all facets of the transition. The ramifications for lack of preparation and inaction will be debilitating.
Below are the major stakeholders in the transition to ICD-10 along with a summary of preparation steps. ADVOCATE’s clients will benefit from a focused and structured plan, including but not limited to the following:
Practice Managers, Billing Personnel & Radiologists:
- Develop an ICD-10 Implementation Team to ensure all billing systems and vendors are prepared.
- The Implementation Team should develop a comprehensive check list, with due dates and responsible individuals assigned to each task.
- Actively participate on all enhancement review committees with software vendors.
- Participate as Beta testing sites when possible.
- Retain the capability to submit ICD-9 and ICD-10.
- Provide coders with training materials associated with ICD-10 coding scenarios that will allow coders to access and utilize ICD-10 books and reference material. This will allow coders to become familiar with format and complexity of the new codes.
- All coding personnel should complete a comprehensive ICD-10 training course and an ICD-10 “Train the Trainer” certificate associated with diagnosis thru AHIMA is recommended.
- Provide practice management, hospital staff and radiologists with a list of the top 50 ICD-9 diagnosis codes, mapped to the new ICD-10 codes. This is the first step in educating stakeholders on the new level of specificity needed.
- Review physician dictations now to provide feedback specific to the individual physician needs.
- It will be critical to have access to facility systems to obtain additional information required to code ICD-10 if it is not provided in the radiology report. You should reach out to each facility and obtain that access now, if it is not already in place, because after the go-live, all hospital staff will be preoccupied.
- Practice Managers and billing representatives need to jointly approach each facility, in person and in writing, to gain the facilities commitment that effective October 1, 2014 every radiology order and electronic medical record entry will facilitate the information needed in order to satisfy the specific requirements inherent in ICD-10 coding.
- Obtain sample ICD-10 ready radiology orders and electronic medical record entries to verify that they include the additional information to ensure the necessary level of specificity is being met.
- Participate in educational seminars within each hospital system to ensure providers and hospital staff are being educated and trained properly and timely to meet ICD-10 requirements prior to the October deadline.
- Dedicate a specific team to monitor the readiness of all payors.
- Although CMS will not be conducting any testing prior to go-live, test with any payors who are willing to participate.
- Even with the best of preparation efforts, there will be a significant negative financial impact due to the hospitals and the payors lack of testing and preparation.
- It is recommended that all practices have an ample line of credit in place prior to October 1, 2014.
As we move through the preparation process, we will provide quantitative analysis to forecast potential impacts. This transition will involve many stakeholders, including hospitals, payors, the government, practice staff and your billing personnel. It is up to each practice to apply the right amount of pressure in the appropriate areas, at the appropriate time, in order minimize the impact of the transition.
ADVOCATE will continue to keep you informed on this and all issues impacting your practice.
Kirk Reinitz, CPA