Tips for going beyond ICD-10 readiness

Aug. 26, 2015
Kim Williams, Executive Director of Payer Intelligence, athenahealth

It’s only a month away – the big, bad, dreaded switch to ICD-10. In the years leading up to the transition, pundits have harped on the financial impact of the conversion to practices. In a 2014 study, the American Medical Association (AMA) estimated the high costs associated with the transition to ICD-10: for small practices between $56,639 and $226,105, medium-size practices between $213,364 and $824,735, and large practices between $2 million and $8 million. The greatest spend was associated with software upgrades, training, practice assessments, payment disruptions, and productivity losses during and after the transition. Since this study was published, the industry has seen how costs and resources required to transition to ICD-10 can vary greatly, and the impact of ICD-10 to reimbursement is expected to be as variable. Because of this uncertainty, it is essential to plan for mitigating risk of payment delay and disruption.

Can you ICD-10-proof your practice?

What can you really do at this point? The key is to take the last steps to conduct training and familiarize your providers and staff with the codes and accelerator tools available, while also looking ahead post-Oct. 1 to ensure contingency plans are implemented. Here are a few areas of focus and some tips to help with last-minute prep:

1. Control your internal processes

Can you answer these questions for your practice?

  • Do you know which ICD-9 codes are commonly used on your claims? How are they changing in ICD-10? Some similar-looking codes will have a different meaning in ICD-10. For example: V202 Routine Infant Care in ICD-9 becomes V202xxx Motorcycle Accident Injury in ICD-10.
  • Are your providers prepared to document to the new, more-granular level of specificity? Have your clinicians and billing staff completed training?
  • Do you know how long it will take to search for a new code?
  • What quality programs do you participate in that require diagnosis codes and/or diagnosis-related groups?
  • Will diagnosis-based utilization review or population management reports change?

TIP: Practice code in ICD-10 on real patient claims and encounters well before Oct. 1. Don’t rely on classroom training to fully prepare your staff for life after ICD-10 – by the implementation date, you and your staff should already have some familiarity. If you haven’t done this yet, use this last month to do so.

2. Hold vendors accountable

Has your practice coordinated with all relevant vendors, and can you answer key questions about your vendors and software?

  • Can you name all the vendors with whom you exchange diagnosis information?
  • Have you coordinated with external partners with whom you exchange data?
  • Do you have ICD-10-ready software?
  • Have you tapped your technology partners to enlist their ICD-10-ready EHR-certified services to help assess readiness and train your staff?

TIP: Be sure your technology partner takes the effort to test every connection. Your technology should be nimble enough to modify quickly pre-transition and, most importantly, post-transition to changing requirements. This includes making continuous updates to all relevant claim-generation requirements and formatting.

3. Brace for payer disruptions

Have you been partnering with payers for testing and post-transition planning?

  • If you have not already tested with payers, it will be too late at this point in the game, but all is not lost. Reach out to your vendor, and see if they conducted testing on your behalf. Also, ask your payers about their plans following the transition. Do they have a contingency plan? How will you be able to reach them if there is a problem?
  • Address gaps in payer readiness, and plan for what could go wrong. Even if it seems that you are ready, you don’t want to assume the payers will be as well. If you send the correct code, are you certain of the response from the payer? Plan for your practice’s reimbursement to be disrupted, and think about how you will manage issues that arise. For example, which team member will be directly responsible for which tasks? This process should include payer and interface testing, as well as other areas in your workflow.
  • Use your current knowledge of payers to your benefit. What is your current claim denial rate and claim re-work burden? As you plan for this to increase, prepare for additional resources to handle a possible increase in outreach to the payers (phone calls, faxes, and portal work) required for ICD-10 claims.

TIP: It is a good idea to plan for cash-flow disruption even if you feel prepared. It may seem that you are ready and you are confident that things will go smoothly, but you need to have a contingency plan in place for the unexpected areas outside your practice’s control. Consider how long the disruption may last, and implement a financial contingency plan.

It’s all about the network

Preparing for ICD-10 can feel like a stressful and arduous process, but it doesn’t have to be. Remember, you don’t have to (and quite frankly can’t) do it alone. Lean on your external partners and constituents, especially your vendor, to help identify and execute the changes your practice needs to make to your processes and systems. Working together as closely as possible will ensure a smooth transition.

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