ICD-10 diagnostic and treatment code conversion is coming fast. Are physicians, practices and staff ready to implement the plethora of changes? Comparing ICD-9 with ICD-10, you'll see that ICD-10 has almost five times more diagnostic codes. But wait--there's more.
There are more than 29 times the treatment and procedure codes for ICD-10 than existed with ICD-9. This presents enormous challenges and pitfalls with the coming conversion. This almost total overhaul and redesign of code standards that your practice has used for around three decades.
While your billing staff's names have changed, they all were familiar and comfortable with ICD-9 responsibilities. Even though the US Department of Health and Human Services (HHS) has once again delayed ICD-10 implementation until October 2014, there should be no further delays.
Physicians should be preparing for this massive transition. But are they? The entire medical community lobbied HHS for this last implementation delay, particularly practice and hospital IT departments that felt their systems were severely challenged to comply.
Physicians and practice managers can use the following as a master checklist to evaluate their preparation progress. AMA has a slightly different checklist that is equally effective and includes a projected timeline.
- Impact analysis. All medical service providers are aware the ICD-10 conversion will impact their practices. That's not enough. A thoughtful impact assessment is more valuable than an informal understanding of the issue. Your analysis should also address the "how will it impact" question and an honest answer of the "how much will it impact" question for the practice.
- Readiness report. Physicians should answer the following question: What do I need to do to have my practice ready for ICD-10? Similar to the results of your impact analysis, assessing your readiness will generate more "to dos" than you first assumed. You may be amazed at the readiness tasks you didn't consider initially, such as talking to your vendors about the transition.
- Create an implementation road map. This is a critical component of your preparation activities. Waiting until just prior to implementation date to design your transition plan is an invitation to potential disaster.
- Establish ICD-10 training plan. The incredible number of changed and additional codes are already taxing the confidence of experienced billing personnel. The only way to protect the practice and its personnel from inadvertently causing claim reimbursement delays and denials is to ensure thorough education and training for the new codes. You also must include training for changed payer claim submission procedures and billing software modifications.
- ICD-10 risk management analysis. Physicians should target the risks the practice faces with this code overhaul conversion. Naturally, the overriding risk is loss of revenue from incorrect claims documentation. Yet, there are varied components to accurate and timely reimbursement submissions. Physicians should list and evaluate the risks inherent in the billing process with the thousands of new codes.
- Incorporate HIPAA Omnibus Rule education. Preparing for ICD-10 conversion should also include a plan to offer education the major provisions of the new HIPAA Omnibus Rule and its impact on billing codes. Physicians should also make staff aware of the severe monetary penalties for violations to encourage staff diligence.
- Create a revenue cycle management plan. Whether you hope to use internal staff or a leading outsourcing firm, such as M-Scribe Technologies, to manage your billing and revenue cycle management, you must design a plan that projects to work after the ICD-10 transition. This is a vital part of effective preparation for the conversion.
Physicians can add other items to their checklist, but it is unwise to eliminate any of these key components from your preparation plan. You must prepare for this major transition with thoughtful consideration of all the risks, expected disruptions, possible human errors and potential revenue cycle shortages. Proper preparation will minimize the potential downside effects of the ICD-10 transition.