In our last post, we looked at how providers can develop an implementation strategy, including an assessment of the impact of ICD-10 on their organization. This post will explore other key ICD-10 transition steps after your initial assessment.
Start by contacting your business associates periodically to follow up on their readiness status. This includes payers and system vendors. Ask them for updates regarding their ICD-10 transition process and any changes to their readiness timeline. Also, along with your coding staff, continue to increase your familiarity with the ICD-10 code sets and the associated coding guidelines. Inpatient coders should start familiarizing themselves with ICD-10 definitions, such as root operations and approaches.
Next, complete any tasks identified during your impact assessment, including implementing system changes and completing internal testing of system changes. Once vendors, payers and other business associates are ready for testing, begin the testing process and modify or develop policies and procedures from your initial assessment.
Also, start to educate other individuals in your organization (besides coding staff) identified during your assessment. Educate these individuals about differences in the classification of diseases and procedures in ICD-10 and what their role in the ICD-10 transition process will be. Continue to modify the ICD-10 project plan and timelines as needed and assess the quality of medical record documentation. If medical record documentation is lacking, implement documentation improvement strategies and monitor the impact of these strategies. Lastly, this stage should include assessing the potential reimbursement effect of transition; communicate with your payers about these anticipated changes.
Stay tuned to the ICD-10 Implementation Is Less Than A Year Away: What You Need To Do To Be Ready series to learn more tips for a successful transition to ICD-10.
CMS has officially announced the new deadline for ICD-10 implementation as October 1, 2015.
“Deadline for ICD-10 allows health care industry ample time to prepare for change.
The U.S. Department of Health and Human Services (HHS) issued a rule today finalizing October 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the International Classification of Diseases.
This deadline allows providers, insurance companies and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready to go on Oct. 1, 2015.”
In March, CMS and Medicaid Services accepted 89 percent of ICD-10 front-end test claims that were submitted by providers, suppliers, billing companies and clearinghouses. 2,600 participants submitted over 127,000 claims with ICD-10 codes to the Medicare fee-for-service claims system; some regions reported acceptance rates of 99 percent. Out of all the testers, clearinghouses submitted the most with 50 percent of claims. Potential testers can submit acknowledgement test claims anytime up to October 1, 2015. However, CMS suggests that providers wait until after October 6, 2014, when Medicare updates its systems, to submit claims. CMS is “expected to publish an interim final rule that will mandate the use of ICD-10 coding beginning on that date.”
President Obama has signed into law the Protecting Access to Medicare Act of 2014 which prevents a scheduled payment reduction for physicians and other providers who treat Medicare patients from taking effect on April 1, 2014. The law maintains the 0.5 percent update for those services that applied from January 1, 2014 through March 31, 2014 for the period of April 1, 2014 through December 31, 2014. In addition, it provides a zero percent update to the 2015 Medicare Physician Fee Schedule (MPFS) through March 31, 2015.
For providers, the impact of ICD-10 is widespread. Stakeholders will be regrouping to determine how to proceed in regards to education, training, documentation, electronic medical records, billing, auditing, quality reporting and compliance.
Please see the CMS MLN Connects Weekly Provider eNews website for reference
Earlier this week, the Senate voted to delay ICD-10 implementation, as well as to approve a temporary 12-month patch to the SGR payment formula that will prevent deep Medicare cuts. Some groups have expressed dissapointment in the decision, but for many physicians, the delay is a relief. Although some large health systems and hospitals were prepared, many physician practices lagged behind.
Now, physician practices face another challenge in deciding when they should invest in the resources to prepare for the switchover. Experts say that practices should keep preparing for the conversion by “wrapping up any loose ends on their EHR implementation and ensure their EHR will be ICD-10 ready.”
According to a new study, providers may experience financial and information losses when they transition to ICD-10 in October. Researchers focused on outpatient codes associated with hematology-oncology diagnoses in 2010 that were pulled from databases in the Illinois Medicaid program and the University of Illinois Cancer Center; they then translated the current ICD-9 codes to ICD-10 using a “specially devised Web-based tool,” which resulted in “significant information loss.” In total, the 39 ICD-9 Medicaid codes cited for information loss accounted for 3% of the doctors’ total Medicaid reimbursements and more than 5% of the cancer center’s billings. Researchers note that part of the problem is that the code translation system from the CMS is complicated and difficult to use.
Experts are describing the upcoming conversion to ICD-10 as chaotic, but suggest providers can avoid this by making sure they prepare ahead of time. CMS administrators have already stated that they will not postpone the October 1, 2014 start date for the conversion. This past week, CMS authorized contractors processing Medicare claims to perform one-way testing with certain providers submitting ICD-10 coded claims; CMS officials have also stated that they plan on conducting more robust end-to-end testing during the summer. As of now, providers should invest in physician training on documentation “with the more complex and granular ICD-10 codes” as a “key mitigation strategy.” In addition, improving external and internal organizational communication between technology systems vendors, internal IT departments, health information management staff and physicians is key to a smooth transition.