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ICD-10: 5 Steps to Take Now
In order to reflect advancements in medical knowledge and technology, the U.S. Department of Health and Human Services has mandated all health organizations begin use of the ICD-10 code set no later than October 1, 2014. This conversion will require tremendous effort from the health care community. The conversion to ICD-10 is daunting.
Due to the numerous upgrades that will be needed to both software systems and manual processes, health care providers must begin preparing now. Those who do not take steps immediately put the stability and financial health of their private practice at risk.
ADP AdvancedMD practice management software is an all-in-one solution for medical coding and billing. ADP has the knowledge and expertise to be your partner during the ICD-10 conversion.
With AdvancedMD, you will be able to quickly look up and apply more than 68,000 ICD-10 codes. Creating a comprehensive conversion plan now, which includes implementing sophisticated software, will give you an advantage come the October 1, 2014 deadline.
ICD-10 Prep for Small Practices: 5 Ways to Get on Track
Recently, the Workgroup for Electronic Data Interchange released findings from an ICD-10 readiness survey that demonstrated a high degree of procrastination in how actively health organizations were working toward compliance with ICD-10.
If your practice is among those only partially ready or just in the initial stages of a transition plan, here are five key tips to keep moving forward toward compliance:
1. Make sure trading partners are on track. The most important step to a smooth ICD-10 transition is to look closely at trading partners. It’s important to focus first on your biggest payers. Will they be able to support your practice after the conversion deadline? Do they have a clear transition plan with milestones that are already being met? If not, your practice needs to understand why. Achieving compliance requires a cooperative effort among entities, and any trading partner showing signs it may not meet the deadline may require your practice to seek alternative partners. What would it take (in time and money) to transition to working with these new partners should the need arise?
2. Test systems for process flow. Start testing your practice’s internal systems, such as its information management, billing, and scheduling systems. Simulate a typical patient visit to the office and send data from each step to test the viability of work flows and flush out where bottlenecks occur. Remember that with each identified disruption, there is likely a correlated negative impact on revenue that should be calculated and rolled back into the plan (see Step #5: Revisiting the plan).
3. Test with trading partners. Once your practice’s internal systems pass your tests with flying colors, conduct end-to-end testing in cooperation with your external partners. An AHIMA/eHealth Initiative survey reveals that 65 percent of organizations will be able to begin testing before the 2015 deadline; 63 percent will begin those tests this year. That’s good news for some of the industry, but your practice’s entire ecosystem will succeed or fail based on how well the collective functions together. Start by sending the most common types of test claims using ICD-10 codes. You may need to shift timelines to include the use of testing environments and the additional time that may be required to adjust to processing the test claims. If your practice has a large number of trading partners, test with the biggest ones first.
4. Survey your practice management vendor. Your practice management vendor is one of the most important pieces of the process. Review the CMS checklist of questions and the recently released list of 15 ICD-10 readiness questions. Will your PM vendor’s software require any hardware upgrades? Can its solution handle both ICD-9 and ICD-10 codes? Dual coding is important to mitigate the risks of being totally down should something go deeply wrong with using ICD-10 coding. What resources are available to help with test transactions? Review the vendor contract and examine the cost/benefit of any changes that will cost time or money.
5. Revisit the budget and implementation plan. After you take the above steps, revisit the budget and re-assess existing implementation plans. The e-Health/AHIMA survey reveals 35 percent of practices believe their revenue will go down after October 2015. Expected areas of difficulty include coding, documentation, and reimbursement.
While getting ready for ICD-10 is a massive process for a practice, the challenges are not insurmountable. Sharing and collaboration of best practices among organizations is a wise use of effort, and trading partners may already have dedicated resources to test the claims process with a variety of partners simultaneously.
Most importantly, don’t lose sight of the fact that beyond compliance, there is an industry upside to using ICD-10. The new codes are superior and in the end, it’s all about increasing the quality of care.
Michael Bearnson works in the Medical Business Solutions center of excellence at ADP AdvancedMD and has functioned as the ICD-10 project manager for the past two years. He has over 20 years of experience with business process improvement. Follow him on Twitter at @ICD10Posse.
Why Coding for Medical Necessity is So Crucial with ICD-10
The switch to ICD-10 is coming on October 1, 2015, and to transition successfully, healthcare providers will need to change not only the actual codes they are using, but also the way they think about coding. Because with ICD-10, it’s not just about coding patient diagnoses correctly; it’s about coding the correct patient diagnoses.
This point is especially relevant to physical therapy providers. As this article explains, “Medical necessity can be a big problem in the physical therapy department.” Why? Well, in many cases, the condition a physical therapist treats is not technically the same condition that the referring physician treated. Sure, the patient may be seeking therapy for a condition that resulted from the original injury or condition—a common scenario for therapy referrals—but with ICD-10, it is absolutely crucial that the diagnosis coding accurately reflects that distinction.
To cut to the chase, that means a physical therapist cannot simply copy whatever ICD-10 code a physician sends over with a referral patient, because there’s a good chance that diagnosis code doesn’t validate the medical necessity of therapy treatment—and that means payers could deny reimbursement for the therapist’s services. The above-cited article offers the following example: “A patient suffers a stroke and is attending physical therapy. A lot of patients suffer strokes and don’t need physical therapy. The therapy is actually treating the residual effects of the stroke, so that’s what should be reported as the diagnosis on the claim form.”
Furthermore, the article addresses the now-common practice of using diagnosis code “cheat sheets” to ensure payment. As you probably know, certain CPT codes are only payable when used in conjunction with certain ICD-9 codes. For that reason, many providers stick to the codes they know will work—and often, those codes fall into the “generalized” or “unspecified” categories. But one of the main battle cries of the new code set is increased specificity, and the transition to ICD-10 represents a giant step away from the use of unspecified codes (unless one of those codes truly represents the most accurate description of a patient’s condition). Thus, if you submit an unspecified code when a more specific code is, in fact, available, you could put yourself at risk for claim denial.
And in the event that you do receive a denial, make sure you investigate the reason. The article I referenced earlier urges providers to research the following question: “Are the denials due to a lack of medical necessity or a lack of documentation?” The author also recommends that each practice designate one person to be responsible for following up on such denials.
Does your practice have a game plan for any claim denials you receive due to ICD-10? What advice or questions do you have?