The implementation of ICD-10 codes will have a financial impact on all practices. Practitioners will need to prepare for situations ranging from software errors that prevent reimbursements to the cost of staff training.
This requires a strategic plan that addresses the potential for multiple problems that will directly affect a clinic’s financially security and well-being.
Maintain Cash Reserves – Plan Ahead
A practice’s cash flow depends on coders/billers obtaining the best turnaround times on claims and that may not happen in the early months of ICD-10 implementation.
The reimbursement process will undoubtedly experience slow-downs and clinicians would do well to have sufficient cash reserves on hand to pay the bills and staff during the growing pains the new system is sure to suffer.
It’s best to acquire a business line of credit or a business credit card with a 0% APR for six to nine months to help tide over the first few months after ICD-10 is enforced.
Training And Education Essentials – Invest in Resources
Some practice owners will be fortunate to have staff training provided by vendors. Those who aren’t will be required to locate competent contractors who can provide the specialized training and education required for the implementation.
Everyone within the practice will require training. This includes the billers/coders as well as clinicians, who will need to modify clinical documentation to justify the increased specificity with the ICD-10 coding system.
Without enough training, bills will keep coming back to practitioners to fix, which will delay the entire payment process.
In-House Or Outsourced Billing – Examine Pros and Cons
Practitioners who are considering outsourcing will want to weigh the costs of training for in-house services against hiring an outside firm to handle those duties.
Coders/billers will need substantial training to minimize the disruption of reimbursements.
Experienced billers/coders are already in short supply and it may be better for the practice financially to hire a specialist who has already undergone training.
The Impact Of Security Vulnerabilities – Protect Data
Maintaining security is a very real concern, especially with the array of potential problems surrounding the transition.
Ensuring the security of patient information may include the purchase and installation of security software, while others may incur additional costs from vendors who are responsible for the system’s integrity.
Mistakes, oversights or compliance issues can cost a practice dearly.
Prepare for the Threat Of RAC Audits – Maintain Compliant Documentation
No one wants to hear that they’re the target of a Recovery Audit Contractor (RAC). ICD-10 implementation errors could appear as an attempt at fraud or abuse, causing a stain on a clinician’s reputation and disruption of the practice’s operation.
The best way for a clinic to be prepared is for the clinician to improve their documentation standards with the increased specificity that is necessary to justify the use of the new ICD-10 codes.
A RAC intervention is a lengthy and costly process for a private practice owner. In fact, it has the potential to drive a practice out of business.
The implementation of ICD-10 coding will take a financial toll on practices of all sizes. Preparing for the transition requires that clinicians use all their deductive skills to identify areas where the coding change will have a financial effect and plan for every contingency.
The transition to ICD-10 codes is the most significant change in 30 years and many clinicians still don’t realize that without the new codes, all their claims will be rejected after Oct. 1, 2014.
The deadline for implementation won’t be pushed back again.
Practitioners need to prepare now and establish a timeline to give themselves adequate time for staff training, to update/upgrade systems and conduct testing.
Conduct an Impact Analysis
The code transition will impact systems and people in multiple ways.
Clinicians will need to conduct an impact analysis to determine how extensively implementation will affect both manual and electronic systems.
The American Medical Association has indicated that the process of updating clinician and vendor systems will take up to six months.
Finding a Vendor
Practitioners will need to contact vendors to ascertain costs and how quickly implementation of new software and hardware can be completed.
It’s essential to find a vendor that supports staff training and maintains responsibility for updates/upgrades, while minimizing costs.
Clinicians may find they need to locate a new vendor to meet their needs.
Communication Is Key
No practice stands alone and clinicians will need to communicate with one another, their biller or billing service, vendor, clearinghouses and insurance companies to ensure systems are compatible.
Extensive system testing will be required between all the entities involved and will take two to three months to complete.
Custom Templates and Modifications
Clinicians should begin now to familiarize themselves and staff with the new codes. Documentation may need modification to reflect coding changes, create claims and accommodate data collection methods.
Don’t use cookie cutter templates – create customized templates that are relevant to the practice.
An EMR and billing software that provide crosswalks between ICD-9 and ICD-10 codes are critical.
Training for Success
Staff training will take two to three months.
A training schedule will need to be created that provides every staff member with a working knowledge of the codes and how they will affect their duties, but one that minimizes the effects on daily operations.
Training exercises using the new codes is good practice for the implementation deadline.
The transition to ICD-10 codes can’t happen overnight. It takes extensive planning and communication between all the parties involved. ICD-10 isn’t a catastrophe, but getting caught unprepared will be catastrophic for the survival of practices. One break in the chain anywhere along the line and clinicians won’t be paid.
Many clinicians describe the change to ICD-10 codes as exciting, but others use words that include scary and expensive. Training in the use of the new codes will be required for many employees, especially for coders/billers, which has many in the profession viewing the transition with trepidation.
The American Health Information Management System (AHIMA) has determined that it will require about 16 hours and $500 to fully train coders working in a small practice who are already experienced in ICD-9 protocols.
The training expands to 57-62 hours for all others. AHIMA indicated that most coders should receive their training three to six months prior to ICD-10 implementation so the information remains fresh in their mind.
More Codes For All
ICD-10 contains 141,000 alpha-numeric codes, but all practices won’t use the full complement of codes.
General physicians may use 30 more, while rheumatologists and orthopedic surgeons may use up to 60 percent of the new codes. ICD-10-CM codes are used for a diagnosis and description of symptoms.
ICD-10-PCS codes are those that will be used to describe procedures, but only in the U.S. for inpatient hospital environments.
Easing The Transition
Using an EMR and computer assisted coding will significantly reduce problems. EMRs are capable of handling all the new codes. Additionally, some systems identify potential problems and notify billers/coders before the claim leaves the office for reduced denials.
The systems still rely on human operators and will help alleviate an expected reduction in productivity the new codes will engender.
One problem that many have overlooked is a decrease in morale associated with the transition. Many coders/billers are anxious and nervous about the new coding.
Their primary worry is being able to maintain the expected cash flow to practices. It’s a legitimate concern and one that clinicians and billing specialists will need to work on together.
The Centers for Medicare and Medicaid Services, the World Health Organization, professional billing/coder organizations, and some insurance providers have developed training modules and tools to assist individuals in their quest for reliable training options.
Coders are the professionals that bridge the gap between clinicians and insurance companies to ensure practitioners get paid.
One of the biggest problems facing billers/coders is finding the time to learn ICD-10 coding while maintaining their normal work day with ICD-9 coding.
Online education is a convenient remedy that can be a cost effective solution for practices.
Plan For Contingencies
The best way to learn is by doing and professional coder/biller organizations highly recommend that anyone who will be working with the new codes conduct simulations using actual claims.
The exercise provides practical experience and helps familiarize coders/billers with codes before the official rollout.
Clinicians need to establish a crisis committee to formulate a backup plan to accommodate slow-downs in reimbursements during the first few months.
The U.S. is one of the last countries to adopt the ICD-10 coding and it’s coming at a time when many practices are still involved in meeting meaningful use standards and changes associated with Obamacare.
When Canada implemented ICD-10 codes in the 2000s, productivity was sharply reduced for months and the same is expected for the U.S., but many problems will be greatly alleviated through appropriate planning.
ICD-9 codes were originally designed as a classification system to compile statistics, but as a code set, ICD-9 does not provide the information that payers desire for reimbursements or the type of data needed to monitor situations that include disease outbreaks by entities like the Centers for Disease Control (CDC) or the World Health Organization (WHO). In other words, it is now an outdated code set.
Implementation of the new International Classification of Diseases is mandatory and there are a number of compelling reasons for the transition, from patient management to identifying and addressing potential pandemics.
The codes were developed by the health division of the United Nations and the U.S. is one of the last countries to implement the codes, a move that has been criticized by other nations.
Codes For A New Era
The ICD-9 system is running out of number combinations to adequately describe new diseases and illnesses, terminology and technological advances since its implementation in 1979. The ICD-10 codes employ an alpha-numeric diagnosis and procedural system that’s more specific.
ICD-10 is designed for significantly more specificity and accuracy, which can increase the amount of documentation required for reimbursements.
The new system offers the ability to code for new diseases, techniques and procedures as they emerge in coming years.
Identifying Fraud, Trends And Abuse
The new codes provide additional oversight for payers, allowing them to identify instances of fraud, trends among practitioners, and individuals who are abusing the system.
It’s a tool that insurance companies have indicated can be used to significantly reduce the cost of healthcare.
Utilization of ICD-10 codes allows payers and professional organizations to monitor how clinicians are utilizing available resources in an effort to provide better patient care and effective management to reduce overall costs.
The new codes provide payers and government officials with a means to grade the individual performance of medical providers and facilities, establish reimbursement rates and set public health policies.
Improved Analytics For Practitioners
The new codes offer analytic tools for clinicians, allowing them to track patient illness, injury and disease trends.
Clinicians will have enhanced tools to monitor instances of everything from cancer and domestic abuse to diabetes and obesity rates.
Practitioners have no choice but to transition to ICD-10. Modifying patient records to reflect the new codes will require a significant investment of time and effort, but many medical professionals are looking forward to a change that has the potential to improve patient care.
A massive change is coming to the medical billing arena on Oct. 1, 2014 with the official rollout of the ICD-10 codes. ICD-10 codes will replace the ICD-9 codes currently in use, adding more than 68,000 new coding options that will directly affect documentation, billing and reimbursements for all healthcare providers.
It’s essential that practitioners begin preparing now to reduce potential payment problems and delays when the new codes go into effect.
So who does this impact?
Does it impact the front desk, the clinician or the biller?
The answer – It impacts every single person in your practice. Those who won’t prepare will learn the hard way, and the lessons will reverberate through the staff for a long time.
Here are 10 things to know to prepare your practice for the upcoming ICD-10 code switchover on October 1, 2014.
1 – ICD-10 Replaces ICD-9
After Oct. 2014, only ICD-10 codes will be accepted for billing and diagnostic purposes. Remember, this applies to the date of service, not to the date of submission of the claim. So if the date of service is before October 1, 2014 and submitted after October 1, 2014 (and there will be several cases like this in your practice), you’ll still use ICD-9 to code those visits.
Any claim with a date of service after October 1, 2014, that doesn’t use ICD-10 codes will automatically be rejected, but practitioners can’t use the new codes before the official launch date.
The new alpha-numeric codes represent the International Classification of Diseases for expanded accuracy.
2 – The Change Is Mandatory And Necessary
It’s a mandatory transition that all clinicians must make if they want to be paid. The codes reflect new diseases, conditions, treatments and technological advances.
It’s the first update in 30 years, providing clinicians with additional coding tools to diagnose and treat patients.
3 – ICD-10 Codes Affect Everyone
The new codes affect all healthcare providers, from clinicians to hospitals. Being prepared will minimize delays and denials in payments and ensure that everyone in the office is familiar with the technology being used to implement the change.
4 – Your EMR Should Map ICD9 to ICD10 to SNOMED Codes
An electronic medical record sofware like In Touch EMR will help your practice adapt to this monumental coding change. Sophisticated systems like In Touch EMR will seamlessly managing all the new codes and allowing your practice to bill efficiently. The system you choose must have a crosswalk between ICD-9, ICD-10 and SNOMED codes built in. A system like this will allow you to generate compliant documentation and clean claims, allowing you to maintain or increase cash flow in your practice.
Here’s an example of a crosswalk, which should automatically exist in your EMR system. This crosswalk will train, and alert your clinicians about ICD-10 and make the transition seamless.
We’re going to use the sample ICD-9 code of lumbago, one that most rehab professionals are familiar with.
M545 Low back pain
SNOMED Concept ID(s)
279040009 Mechanical low back pain (finding)
402245001 Angry back syndrome (disorder)
298236009 Lumbar spine stiff (finding)
279039007 Low back pain (finding)
247368002 Posterior compartment low back pain (finding)
301407002 Tenderness of right lumbar (finding)
279041008 Lumbar trigger point syndrome (finding)
278860009 Chronic low back pain (finding)
301408007 Tenderness of left lumbar (finding)
278862001 Acute low back pain (finding)
300957005 Postural low back pain (finding)
279042001 Lumbar segmental dysfunction (finding)
161894002 Complaining of low back pain (finding)
267982002 Pain in lumbar spine (finding)
202794004 Lumbago with sciatica (finding)
As a clinician, you need access to this crosswalk at your fingertips, as the countdown towards October 1, 2014.
When the big day comes in October 2014, this ‘crosswalk capability’ in your technology will make your transition seamless. Without this capability, practices and billers across the country will be scrambling to adjust to the new changes.
Even if you don’t have a crosswalk like this built into your EMR system, you’ll need to purchase / identify crosswalk data for the most common ICD-9 codes in your practice and start studying that data right away.
5 – Early Preparation Is Critical
The change-over takes place promptly on Oct.1, 2014 and reflects a one-year delay issued by the Department of Health and Human Services. While that may sound like plenty of time, early preparation is critical to the process.
Clinicians will need time to install any needed software, train employees, conduct tests and work out any bugs in their system.
An implementation strategy must be developed, along with a timeline and impact assessment evaluation. Practitioners will need to communicate with vendors, clearinghouses and insurances agencies to ensure security and compliance.
6 – CPT Codes Will Stay The Same
ICD codes are for making a diagnosis and current procedural terminology (CPT) codes are for medical and rehab billing. The next generation of ICD-10 codes won’t affect the use of CPT codes for physician services.
7 – Identify Any Needed Documentation Changes
The change to ICD-10 will require clinicians to modify or change their documentation processes. In fact, a significant increase in documentation time is expected, according to several industry sources.
Practitioners using an EMR must have the ability to create custom templates for documentation.
This will make it easier to implement any changes needed, allowing practices to take full advantage of the codes for enhanced care and revenues.
8 – Make Conversion a Top Priority
The change to ICD-10 codes should be a top priority for clinicians across the nation, even though it will require a significant amount of time and effort to ensure the transition goes smoothly.
The change-over represents a complete overhaul of the coding system and clinicians that don’t invest the time to prepare properly will find significant delays in reimbursements, or potentially costly system glitches.
9 – Be Prepared for an Emergency…
Part of the conversion process includes a contingency plan in the event that a major problem manifests.
Employees should be cognizant of who to contact and be able to do so 24/7 to have their office systems up and running again quickly. It’s best for practices to have a financial contingency in place in case payments are delayed or paused for a period of time. A line of credit, or access to emergency funds is important to meet expenses like rent, payroll and supplies.
10 – Invest in Education for your Staff
The best thing practitioners can do for their practice is to educate themselves and their staff to keep informed of any changes relating to the coding change.
Identify and schedule training for anyone within the office that will be directly involved with the billing and coding process. The clinicians and the billers need to identify courses on ICD-10 preparation and study crosswalks by working closely with their EMR vendor.
The change to ICD-10 codes is mandatory, affecting everyone in the healthcare industry and the time to prepare for implementation is counting down with each day.
Clinicians have a variety of resources to call upon and should make a concerted effort to ready themselves and their staff for the October 1, 2014 deadline.
Practitioners shouldn’t count on another implementation delay because this deadline is not going to be delayed. It’s going to happen and all practices need to be prepared for it.
A patient calls it a sore throat, a doctor calls it pharyngitis and healthcare insurance calls it a 462. Each is accurate, but if the correct ICD-9 code isn’t entered or doesn’t match the diagnosis, the physician won’t be paid for his services.
Designating the right ICD-9 codes is essential to collect reimbursement claims and Nitin Chhoda offers a crash course in the coding system.
ICD-9 codes are the internationally recognized three- to five-digit numerical designations for each condition and disease.
The codes are organized into three categories known as volumes that are used by medical professionals across the nation for billing purposes when submitting reimbursements claims.
Medical Codes Development
Developed by the World Health Organization, the system is comprised of volume 1, a compendium of diagnosis codes for diseases and conditions.
Volume 2, arranged in alphabetical order, provides an index to diagnostic procedures and volume 3 lists procedure codes. The system is set to be updated in Oct. 2014 to the new ICD-10 codes.
The new system reflects advances in medical terminology and technology, and enables practitioners to provide more detailed information to insurance companies. Early preparation for the switch is advised, as those in the medical profession are anticipating some disruptions during the transition.
The Coding System
The ICD system links a diagnosis with a procedure for billing purposes. The codes tell insurance companies why the client met with the clinician, the diagnosis, and procedure or treatment that was provided to return the patient to health. The codes are further broken down into subcategories and sub-classifications.
ICD-9 codes offer provisions for making a multiple diagnosis, which can also be entered in an electronic medical records system. The first diagnosis code is used to explain the reason the client was seeking care. Other conditions may be observed during the examination or be part of the patient’s medical history.
Those are placed second and third on claim forms as contributing factors, already existing conditions and complications, providing a source of supporting evidence.
Medical professionals must also be cognizant of the abbreviations, punctuation and symbols used within the codes, known as conventions.
Proper Coding is Essential
It’s critical that the proper coding is entered on reimbursement requests and that a practice’s billing and coding specialist is well versed in their craft. Codes that don’t match the diagnosis or procedures taken will be delayed, denied or questioned as to the medical necessity of the action taken. Even simple mistakes will severely interrupt a clinic’s cash flow.