In late spring of 2013, an ICD10 readiness survey showed some alarming statistics. It was the seventh in a long line of surveys performed by WEDI (Workgroup for Electronic Data Interchange) that indicated the lack of progress in the ICD10 journey to adoption. With the looming October 1, 2014 deadline quickly approaching, it seems that the extension granted has only delayed the prioritization of this mandate.
As the ICD10 compliance deadline is fast approaching, organizations are ramping up their efforts. This cooperation between Providers, Payers, Electronic Billing Clearing Houses, and Software Vendors is a huge undertaking for any organization. To assist on your ICD10 compliance journey, the follow checklist has been developed.
- Select an ICD10 Transition Team
It is vital that resources be chosen to transition from ICD9 to ICD10. A multidisciplinary team representing clinical, financial, and administrative staff is advisable. The size of this team, of course, should correlate with the size of the organization. However, the steps that need to be taken, are the same, no matter how large or small the organization.
- Perform a Readiness/Impact Assessment and Develop a Project Plan
CMS, AHIMA, & AMA all offer readiness assessments and high level project plans. As a matter of fact, the internet is clogged with resources for this step. Another, perhaps less thought about but valuable resource, is the Medical Society for your county or state.
- Contact Software Vendors
This is really part of the impact/readiness assessment, but since it can derail the timeline, it bears special mention. Practice Management and Electronic Health Records Software vendors have ICD10 compliant versions. Since updating software versions can be as simple to applying a patch or as complicated as full projects that take months to complete, it is important to verify the specifications directly with the vendor.
While we are discussing vendors, it also bears mention to document the charges capture process. For example, is there a paper encounter form that is keyed in by the billing staff? If so, then any ICD9 codes would need to be updated. If it is via electronic submission, then the PM/EHR dictionaries and interfaces would also need to be considered and tested.
Revenue interruption is a very real concern for administrators at this point. It is vital to analyze the accounts receivable for position and mix of Payers. This will allow the team to target the highest payers first during the testing phase to help reduce potential income interruption.
- Communicate with Electronic Billing Clearinghouses
Testing claims to reach the Billing Clearinghouses is a crucial step in the end to end testing of claims. Once successful transmissions have been accomplished, the team can move on to the Payers specific testing.
- Contact Payers for Their ICD10 Readiness and Testing Schedules
Full end to end life cycle testing of claims will need to be performed for each Payer.
- Audit Current Documentation Practices
There may be some good news on this item. On the surface, moving from ICD9’s 17,000+ codes to the 141,000+ codes of ICD10 sounds intimidating. However, consider that the concepts are not new to Providers. In fact, approximately 1/3 of the codes are the same with expanded details of those problems. Some examples are:
- Initial, Subsequent, or Sequela Instance
- Acute or Chronic
- Laterality- Right, Left, or Bilateral
- Normal Healing or Delayed Healing
- Nonunion or Malunion
Many providers have been documenting these details within their notes already as matter of best practice patient care and to limit liability. Auditing current documentation will assist in developing a training plan for providers.
The internet is flooded with training options. Accurately identifying who needs training will dictate the amount of training needed. For example, certified coders would certainly require more training than a front desk staff verifying insurance eligibility. Minimally, the following groups of staff members will need training consideration
- Front Desk Staff, prior authorizations,
- Coding/Finance Department Staff
- Any other Staff who use ICD9’s Currently
After spending the last 20+ years witnessing the day to day challenges facing providers, I am not surprised with the findings of the survey. Delaying the inevitable has just left more room for other issues battling for attention in today’s medical practices. Balancing competing initiatives such as EHR adoption, Meaningful Use Objectives, not to mention making sure patient care is a first priority, has made the healthcare environment very challenging.
How will your organization rapidly address the day to day challenges you are facing? Galen Healthcare Solutions provides a full support system, wealth of experience, and solutions for your EHR journey with the various services we offer. Our Technical, Upgrade, Project Management, and Implementation Professionals are available for large projects, as well as incremental solutions. Let us help you raise the bar in patient care for your organization.