Submitted on Tue, 2015-06-30
By SMART Health Claims

The Deadline is Approaching: Are you Ready for ICD-10?

We are now less than 100 days away from the fast-approaching ICD-10 compliance deadline of October 1, 2015.
 

Local health departments should be prepared or should be urgently preparing to make the switch.

 

Are We Prepared?  What the Research Says

According to a new survey, only 21 percent of physicians’ practices believe they are now on track with preparation efforts to convert to ICD-10  -Forbes

While the medical community is reluctant to accept this change, it is coming. Legislators announced during a recent Congressional hearing that no further delays of ICD-10 are planned, heightening concerns about the lack of preparation by private and public health organizations. A June survey found that 21% of California physician practices are not ready for ICD-10. Astoundingly, 74% of providers had not even started their transition at all. The American Medical Association is now lobbying for a 2-year grace period "during which physicians will not be penalized for errors, mistakes, and or/malfunctions of the system." 

Not everyone is unprepared for the transition though. The Centers for Medicare & Medicaid Services reports that its latest round of end-to-end ICD-10 testing resulted in an 88% acceptance rate. Here is a snapshot:

  • 23,138 test claims received
  • 20,306 test claims accepted
  • 2% of test claims were rejected due to invalid submission of ICD-10 diagnosis or procedure code
  • <1% of test claims were rejected due to invalid submission of ICD-9 diagnosis or procedure code

Local Health Departments Must Work Toward Compliance

In a previous post, we presented the reasons that implementation of ICD-10 is vital for local health departments. Working toward ICD-10 compliance should now top every Local Health Department agenda because all medical claims submitted incorrectly after the October deadline will not be paid.

Here is a checklist from CMS to help you prepare:

  1. Identify your current systems and work processes that use ICD-9 codes: This could include your clinical documentation, encounter forms/superbills, practice management system, electronic health record system, contracts, and public health and quality reporting protocols. It is likely that wherever ICD-9 codes now appear, ICD-10 codes will take their place.
     
  2. Talk with your practice management system vendor about accommodations for ICD-10 codes:
    1. Confirm with your vendor that your system has been upgraded to Version 5010 standards, which have been required since January 1, 2012. Unlike the older Version 4010/4010A standards, Version 5010 accommodates ICD-10 codes.
    2. Contact your vendor and ask what updates they are planning to make to your practice management system for ICD-10, and when they expect to have it ready to install.
    3. Check your contract to see if upgrades are included as part of your agreement.
    4. If you are in the process of making a practice management or related system purchase, ask if it is ICD-10 ready.
       
  3. Discuss implementation plans with all your clearinghouses, billing services, and payers to ensure a smooth transition: Be proactive, don’t wait. Contact organizations you conduct business with such as your payers, clearinghouse, or billing service. Ask about their plans for ICD-10 compliance and when they will be ready to test their systems for the transition.
     
  4. Talk with your payers about how ICD-10 implementation might affect your contracts: Because ICD-10 codes are much more specific than ICD-9 codes, payers may modify terms of contracts, payment schedules, or reimbursement.
     
  5. Identify potential changes to work flow and business processes: Consider changes to existing processes including clinical documentation, encounter forms, and quality and public health reporting.
     
  6. Assess staff training needs: Identify the staff in your office who code, or have a need to know the new codes. There are a wide variety of training opportunities and materials available through professional associations, online courses, webinars, and onsite training. If you have a small practice, think about teaming up with other local providers. For example, you might be able to provide training for a staff person from one practice, who can in turn train staff members in other practices. Coding professionals recommend that training take place approximately six months prior to the ICD-10 compliance deadline.
     
  7. Budget for time and costs related to ICD-10 implementation, including expenses for system changes, resource materials, and training: Assess the costs of any necessary software updates, reprinting of superbills, trainings, and related expenses.
     
  8. Conduct test transactions using ICD-10 codes with your payers and clearinghouses: Testing is critical. You will need to test claims containing ICD-10 codes to make sure they are being successfully transmitted and received by your payers and billing service or clearinghouse. Check to see when they will begin testing, and the test days they have scheduled


Transitioning to ICD-10 requires that billing programs and procedures are up-to-date and prepared to support the comprehensive new coding system. If you have questions about the transition, please reach out to one of our billing experts or schedule a meeting for assistance.

For more information, visit the Centers for Medicare & Medicaid Services home for ICD-10 Resources and information.