Is Your Practice Ready for ICD-10?

A year can go by very quickly. Oct. 1, 2014, will be here before we know it and the Department of Health and Human Services (HHS) has stated it will not extend the deadline for implementing ICD-10. All HIPAA-covered entities must implement ICD-10 for dates of service (or date of discharge for inpatients) that occur on or after Oct. 1, 2014.

ICD-9 is 30 years old and contains outdated and obsolete terms. The code structure in ICD-9 (three-five characters) also limits the number of new codes that can be created. ICD-10 codes will be three-seven characters in length and will allow for greater specificity and accuracy in describing a patient’s diagnosis. ICD-10 will enhance quality measures, improve patient care through research capabilities, provide for more accurate billing, and will reduce opportunities for fraud. ICD-10 will also promote cost effectiveness because more accurate information will be provided to carriers.

Claims submitted for dates of service on or after Oct. 14, 2014, will not be processed unless ICD-10 codes are utilized. Providers who have not already started preparing to transition to ICD-10 should begin by designating a project coordinator who can lead the practice in this process.

Action steps to be completed by the project coordinator should include:

• Develop a timeline that identifies tasks to be completed in order to make the deadline of Oct. 1, 2014.

• Review all electronic and manual systems that use ICD-9 to determine if upgrades or new equipment will be required. Examples include EMRs/EHRs, practice management systems, claims scrubbing software, e-Prescribe, lab interface, test ordering systems and utilization management systems.

• Review all areas of the practice to determine how ICD-9 is currently being used including: scheduling/registration, pre-authorization, medical records, superbills and other forms, coding, data entry, billing, payment posting, customer service and claims follow-up.

• Determine how ICD-10 will affect clinical documentation requirements and EHR/EMR templates.

• Identify all policies, procedures and protocols that will be affected by ICD-10.

• Identify the financial impact associated with the implementation of ICD-10, which includes staff training, an increase in denials or delay in reimbursement, impact of physician productivity, cost of staff overtime and IT system upgrades.

• Ensure adequate time is allowed for testing with billing system vendor and clearinghouse. Practice management systems must be able to accommodate both ICD-9 and ICD-10 codes until all claims for services provided prior to Oct. 1, 2014, have been processed and completed.

The project coordinator should work with the software vendors to test their systems in order to ensure claims processing, eligibility verification, quality reporting, revenue cycle reporting and other transactions using ICD-10 can be processed correctly.

• Ensure proper training of all staff including providers, medical assistants, nurses, coders, front office staff, etc. The American Health Information Management Association recommends that training of staff begin no more than six to nine months before the deadline of Oct. 1, 2014.

A successful transition to ICD-10 requires significant planning and keeping all staff and providers apprised of the many changes that will be made to the practice. If your practice has not already begun the process of preparing for ICD-10, now is the time to get started.

More information concerning ICD-10 can be found at www.cms.gov/ICD10.

Carol Crews, CMPE, CPMA is the director of Healthcare Consulting Services for The LBA Group in Jacksonville, Florida. She has over 30 years of experience in the healthcare profession and in her current position, consults with physician practices and hospitals on all aspects of practice management. She can be reached at 904.224.9787 or via email at ccrews@TheLBAGroup.com.

The LBA Group is also a proud member of the National CPA Health Care Advisors Association. HCAA is a nationwide network of CPA firms devoted to serving the health care industry. Members provide proactive solutions to the accounting needs of physicians and physician groups. For more information contact the HCAA at info@hcaa.com.