The big day for the ICD-10 transition is just around the corner. Practices should have been using their time to train, install hardware and test their software for compatibility with other entities with which they communicate. However, despite the best laid plans and intentions, clinicians may not be as ready as they think. Software systems are a prime consideration and there are steps that practitioners can take to ensure they’re ready when Oct. 1, 2014 arrives.
There are dozens of EMRs available. They have multiple features, but clinicians are often required to pay extra for access to updates and other items that should be included automatically. Practitioners will want to ensure they have an EMR capable of handling the new codes and that they have the latest version available installed.
EMRs must have sufficient security measures for HIPAA compliance to safeguard patient information. Consult with vendors to verify that the EMR is HIPAA compliant, code upgrades are covered in any contracts, and if training will be included.
A crosswalk offers a means of translating ICD-9 codes to the new ICD-10 version. It’s essential that any software include those crosswalks for translation, especially in the early months of the transition. If the EMR doesn’t support crosswalks, clinicians may need to invest in a program to assist with coding tasks.
General Equivalence Mapping isn’t designed for long-term use, but it does provide a valuable resource. It’s a tool that can be used to assist in locating the correct code options and help staff become more fluent and comfortable with the new code selections.
Until everyone in the practice is familiar with the new coding system, a side-by-side coding feature will prove very helpful. It will reduce staff frustration and help everyone rest easy knowing they’ve entered the correct diagnosis codes.
A system that allows clinicians and staff to incorporate the new coding into their everyday duties will help everyone become familiar with the new codes before the deadline. They can also begin using the new codes prior to the implementation date with entities that are ready.
It’s critical that in-house or contracted billing services are prepared for ICD-10. They must be compliant with the new HIPAA transaction standards for transmitting data electronically. Be prepared for a reduction in productivity, even with superior billers and coders.
Testing should include the ability to submit claims and insurance eligibility. The only way to ensure if a practice’s software is ready for the ICD-10 transition is to conduct exhaustive testing in those areas – then test some more. If any glitches or issues do exist, the more the system is used the more likely they will be to become apparent. It’s also important that inter-office systems can communicate with each other.
The software that transmitted a claim perfectly today has the potential not to work smoothly tomorrow. Continued testing is the only way to ensure that problems are identified and addressed prior to the deadline. If for some reason an issue can’t be fixed by implementation day, be sure to have a contingency plan. Relationships with new vendors may have to be established, so be prepared.
Significant coding changes will take place with implementation, but if the practice’s software can’t communicate successfully with insurance companies and clearinghouses to submit claims, they’re of no use and will cost clinics dearly in revenues. Implementation is more than just a coding change. It affects every department. Ensuring the clinic’s software is working correctly will make the transition easier while maintaining revenue levels.
Almost everyone in the medical profession anticipate a loss of income with the implementation of ICD-10. However, some healthcare management and technology firms have postulated that the switch to ICD-10 will present practitioners with opportunities to increase revenues, as it will be easier to document co-morbidities. They also note that the key to increased revenues depends on greater documentation accuracy, one of the stated goals of ICD-implementation.
One of the areas that will be most impacted by the switch to ICD-10 will be the billing department. The ability of billing and coding staff to keep up with the increased coding requirements will have a direct impact on the continued flow of revenues to practices. Staff will need sufficient training in the new codes and even then, it may be necessary to engage additional personnel to address back logs.
After the deadline, any claims that aren’t submitted using ICD-10 will automatically be denied. Coding and billing staff will need the highest level of training available. People learn by doing and whenever possible, it’s a good idea to start using dual coding.
Practitioners that have their billing done by a professional agency will need to consult with the company to ensure the firm is prepared and revenues won’t be disrupted. Part of biller/coder readiness is ensuring that they and the software used is compliant with the strict HIPAA standards governing the electronic transmission of patient data.
Billers and coders may also need a refresher course in anatomy and physiology. The increased specificity of ICD-10 will require more in-depth coding. Billers/coders will find themselves using more specific terms than they’re normally accustomed. Next to the clinician, billers/coders are the most important link in the revenue chain. They must be ready for the transition or revenues will falter.,
Some interruption in the revenue flow will be inevitable. By its very composition, the new alpha-numeric coding system requires billers/coders to switch between a numeric pad and a keyboard, which will result in a slowing of coding claims. Super bills may no longer be a feasible option, requiring billers and coders to learn new forms and formats.
There are bound to be claims that are rejected in error due to the new coding. Claims will require resubmission and coders/billers will find themselves investing a significant amount of time communicating with clearinghouses and payers to determine why claims were denied. No matter how well trained the biller/coder is, those type of instances will slow down the submission and collection management process.
Errors in documentation and rejected claims will result in many patients receiving bills they don’t deserve. While it doesn’t directly affect billers/coders, it will have an impact on practices. Clinicians will see an increase in calls from panicked patients, requiring time and a cool head to explain and sooth clients.
Clinicians must adhere to coding guidelines if billers are to submit accurate claims. Practitioners can’t code for a suspected or probable diagnosis; items that would appear in notes must now be coded; coding should be done at the highest level possible; and a focus should be on medical necessity.
Clinicians and billers/coders have always had a partnership in terms of revenues and that relationship will be even more important as ICD-10 goes into effect. The billing department should be encouraged to seek verification and understanding of any item for which they’re unsure and clinicians should make time for this.
No one can hide from ICD-10. How each team member responds to its challenges will define the ultimate success of the practice and revenue flow.
Patients can be struck by numerous objects leading to pain, disability, physical therapy, and perhaps embarrassment, if the new ICD-10 codes an accurate indicator. Some of the codes seem nonsensical or unlikely. The fact that the codes exist amply demonstrate that these incidences have occurred – and multiple times in some cases.
There’s an extensive array of items that can be thrown, tossed and dropped that will cause injury. Most will lead to a visit to the ER or the physical therapist. Clinicians will definitely want to be ready for patients who have been hit by rowdy wildlife, from dive bombing macaws (W61.12XA) to head butting cows (W55.22XA) who may object to being milked.
If Grandma gets hit by a reindeer, code it as a V06.00xA, but for individuals who get thrown from a sleigh pulled by reindeer, that’s a code V80.929A. People interacting with churlish chickens with a propensity for throwing themselves at bipeds will code as a W6a.32XA. The codes make no differentiation between rubber chickens and real chickens, but there are codes for multiple encounters.
Land animals aren’t the exclusive cause of injuries. For the luckless patients who experience injury at the fins of water-dwelling creatures, it may feel like a script for a disaster movie. Clinicians will find coding options for clients with first and subsequent encounters with outraged orcas (W56.22xA), those who have been exposed to turtles (W59.29) and not-so-playful dolphins (W56.02XA).
Some individuals are just unable to multi-task while doing even the simplest things. Distracted talking and texting has led to multiple mishaps that practitioners will be coding for and may lead to some strange encounters with payers. There’s a code for people running into a lamppost (subsequent encounter, W22.02XD) and when walking the family canine (W54.1XXA).
Mankind is adept at conceiving new ways of having fun and doing it in the most dangerous venues possible. Bungee jumping (Y93.34), parasailing (Y93.19) and even playing a percussion instrument (Y93.32) or Y93.J4 for lips stuck to an instrument, can lead to unwanted conclusions. A friendly game of ultimate Frisbee (Y93.74) is cited as the reason for pulled muscles, broken bones and even whiplash.
Even fun with imaginary and inanimate creatures can be hazardous. Individuals who sustain an injury by running through a snowman, (thereby committing snowman homicide or possibly a hit and run) will code as Y02.8xxA. For those who are confused about where to put the carrot during a snowman build and insert it in their own ear, use code T16.2xxA. On the dark side, those bitten by a vampire (superficial bite of other specified part of neck, initial encounter), that’s a code S10.87xA.
When hair causes constriction (initial encounter) clinicians will turn to code W49.01XA and E928.4 for an external hair constriction. For a non-scarring hair loss, there’s code L65.9. There’s no telling when a bad hair day will result in serious injury.
Even the very air is fraught with potential danger. For clients who discover they have an air leak, use code J93.82. Patients may be injured through falling spacecraft (V95.49XA). When clients displace their balloon, code it as a T82.523S, but for victims of a falling alligator, that’s code W5803XA.
ICD-10 codes reflect real incidents and complaints, but the ways in which they’re worded often make them fodder for fun. The primary points clinicians need to remember is that they need to code to the highest level possible and as accurately as possible – even if it results in long conversations with payers who have disbelieving minds. Perhaps they could code for a therapeutic massage.
One of the biggest challenges for clinicians with the transition to ICD-10 will be coding for items that they would normally include in their notes. In the new world of ICD-10, everything has a code and insurance companies won’t reimburse for anything that’s not coded.
The external causes of injuries should be a focus for clinicians and may be the most difficult to remember. Payers want more intensive information about every aspect of a patient’s visit to their medical professional.Practitioners must code injuries, onset of symptoms, external causes and treatment plans.
It’s absolutely essential that professionals in any branch of the medical profession code to prove medical necessity. In some instances, it may be necessary to rely on records from the referring physician to provide acceptable documentation.
Clinicians should always strive to code at the highest level of specificity and detail that’s possible. Practitioners can no longer code for a probable or suspected diagnosis. Payers just want to know about the facts that can be proven by tests and the clinician’s observation.
The process will be smoother and less troublesome if clinicians identify the codes they most often use and convert them to ICD-10 before the implementation deadline. There are thousands of new codes, but clinicians in private practice will typically only use a small number of those, making it easier to begin converting and using them in dual coding.
Before ICD-10, a clinician’s notes were a tool that was used to create an ongoing record of a patient’s health history. They essentially created a database of knowledge that could be referenced about the client. With the implementation of ICD-10, that same information has been reduced to specific codes that determine what clinicians will receive for reimbursements.
The clinician’s expertise with ICD-10 coding will be a determining factor for practice revenues. The GEMs will assist in those efforts to be more specific, but practitioners will want to engage in some preemptive documentation. It will help medical professionals become familiar with the new coding and facilitate the changeover in patient records.
Professional organizations have predicted a 15 percent increase in documentation requirements. Those entities indicate that 65 percent of clinician notes aren’t specific enough for the new ICD-10 coding and will result in a significant increase in documentation times. The sooner that practitioners become adept at coding with ICD-10, the less time will be required as time progresses.
Payers have always sought reasons to deny claims and place the financial responsibility elsewhere. That’s their job. As comprehensive as the new code set is, medical professionals in all fields should be aware that they may encounter substantial difficulties. Many payers are under the impression that ICD-10 has a code for every possible instance, but that just isn’t true.
The current healthcare environment is one in which the focus is on saving money and ensuring that services are actually being received. Payers are no longer content to reimburse without practitioners without providing detailed to ensure the treatment is appropriate and is actually being carried out.
To accomplish that task, practitioners now have more specific coding, along with additional coding for documenting details about the causes and circumstances surrounding the patient complaint. Notes are no longer sufficient for that purpose and a practice’s revenue stream will directly depend upon the clinician’s ability to locate the appropriate codes to provide proofs in an alphanumeric fashion instead of words contained in notes.
Those who identify their most often used codes and begin rewriting their notes to conform to ICD-10 protocols have a better chance of mitigating denials once the new coding goes into exclusive use. The ICD-10 transition will be difficult enough. Taking the initiative in rewriting notes now will save time in the future.
The type of ICD-10 training needed by clinical staff will depend upon a variety of factors. An advanced level of ICD-10 training will be required for any clinical staff that works directly with patients to provide medical care.
The role of clinical staff has changed over the years. Nurses, therapists and nurse practitioners are now on the forefront of patient care. Many work directly with super bills that may be eliminated and new methods must be learned.
New provisions in HIPAA compliance affects the dissemination of protected patient information. Any clinical staff in a practice that is involved with providing patient care or access to client health information will need a thorough understanding of ICD-10 coding, including staff that provides in-home therapy or care.
Depending upon their level of education, the individual practice, and the laws within the state, clinical staff can conduct exams, make diagnoses, give injections and are authorized to prescribe medications. They can prescribe physical therapy services, make referrals and order testing. These staff members will need specialized training in ICD-10 coding.
Health care coverage is undergoing major changes due to the Affordable Health Care Act. Depending upon the individual practice, clinical staff may be responsible for scheduling referral appointments and obtaining pre-authorizations. Clinical assistants will be affected by changes in health insurance policies and advanced beneficiary notices (ABNs) that will need to updated and reformatted.
One of the responsibilities for non-coding clinical staff will be to educate patients about all of these changes and how they will be affected. Clinical staff may also include technicians for practices that maintain on-site lab and testing facilities. In smaller practices, a single individual may wear many hats and ICD-10 training options must take that into account.
Large, comprehensive practices may encompass case workers, patient advocates and staff that oversee sales of medical products and devices. Clinical personnel in these capacities may need ICD-10 training, but not the intensive level of those who must enter ICD-10 coding. For many non-clinical personnel, the biggest shift with which they may have to adapt is procedural changes.
A byproduct of the Affordable Health Care Act is that patients will have increased access to their health information through patient portals, but it may result in an increased work load for clinical staff. A patient portal allows clients to access test results and other information, but it could result in an influx of calls to which clinical staff must respond.
The patient understanding of what medical personnel told them and subsequent coding may not be an exact terminology match, leading clients to contact the practice for clarification. Any terminology with which patients are unfamiliar or they disagree may result in calls and an additional workload.
Conversely, the greater specificity that coding clinical staff can utilize may be appreciated by older patients. ICD-10 allows clinicians to more accurately describe their level of pain or disability. The in-depth information may result in increased services for chronic conditions and pain management programs.
The bottom line for practitioners is that every member in the practice will need some type of familiarization with ICD-10 coding and/or the procedural changes the transition will engender. A careful analysis must be conducted to identify the level of training and ability each person has to provide effective training for everyone from the front desk and clinical staff to management.
The transition to ICD-10 encompasses much more than simply acquiring the codes and using them. It’s an involved process that requires careful planning, organization, funding and training. With the Oct. 14, 2014 implementation date just a few months away, it’s imperative that clinicians have an action plan in place to meet the deadline. Failure to be ready will result in practices being out of compliance and the denial of reimbursements.
Make A Plan
Planning is key for ICD-10 implementation. The plan must include a timeframe for all the changes and training to be completed, along with a review of the regulations and requirements for transition. ICD-10 can’t be put in place piecemeal. Solicit volunteers or appoint a single individual or team that will be in charge of ensuring each planning step is accomplished.
Break It Down
The transition will include several phases, from the installation of software and hardware to staff training and equipment testing. Break the implementation process into smaller bites to make it more manageable.
Discover if there are any steps or measures that must be completed by a certain time. Clinicians should select a single person or a team to oversee each additional phase of the transition. These individuals will be responsible for ensuring training, IT, software, funding and other associated steps are addressed and completed correctly.
No action plan can be launched without knowing what the impact of ICD-10 will be on the practice. Practices are not the same, even within the same field or specialty. ICD-10 will affect documentation, billing and coding, and the practice’s technology, along with staff education, procedures and funding. An in-depth assessment of the practice and staff will identify areas of concern.
Two of the most critical departments are billing/coding and documentation. Constant and continued communication with vendors, payers and clearinghouses must be maintained to determine compatibility during testing phases. This is also a good time to discover any changes in reimbursements that may be coming in the future. Documentation practices will need evaluation to ascertain if they’ll meet ICD-10 coding requirements.
Implementation is going to be expensive. Funding will need to be secured for a multitude of expenses, many of which may change along the way. There will be costs associated with software upgrades. Practices that opt to maintain their own on-site server will require equipment purchases and advanced security protection.
Until all patient data has been transitioned to the ICD-10 system, clinicians will be utilizing dual coding. The most recent version will be needed in software and printed form. There will be hardware systems to upgrade and software to install. Technical modifications may be required to meet HIPAA standards or meet high-speed data transmission.
Training staff in the use of ICD-10 and new privacy guidelines is necessary, and clinicians should be prepared for a loss of productivity. A wide array of professional organizations and companies offer training in multiple formats. All staff members won’t require the same amount of education and not all people learn the same way.
Training services offer sessions that incorporate eLearning, interactive exercises, and mobile and smartphone applications, along with classroom education, discussion forums, practice tools and simulations. Some customize the training to the individual. Clinicians should ensure that the training entity maintains an appropriate means of ensuring that each staff member is proficient.
Clinicians should be aware that the ICD-10 transition requires new knowledge, skill sets and procedures. Not every staff member may be able to make the transition successfully. New staff may need to be hired to replace those unable to cope with the changes. Training should begin with coders, clinicians, clinical staff and other staff, in that order. Everyone should be aware of the training schedule.
Practices should begin internal testing of their new hardware and software systems to address the inevitable problems that come with such a major undertaking. IT professionals will be a common sight in practices as they perform upgrades, test systems and address problems, all of which can result in productivity losses. Be prepared.
When internal testing is complete, practices should begin testing their systems with clearinghouses, insurance companies, payers and vendors as soon as possible. Staff should know when testing is scheduled and be prepared for interruptions. Conduct simulations and test runs to ensure communication with critical entities and develop a contingency plan for any potential problems.
HIPAA compliance standards must be met for the secure transmission of data. Clinicians work with a host of pharmacies, labs, hospitals and other physicians and they’ll also need to communicate securely and seamlessly with those entities. This is also the time when clinicians should determine which ICD-9 codes they use most often and map them to the ICD-10 version.
Once all system software is working in concert with critical entities, begin dual coding as needed. Create an ongoing plan for determining the source of any errors or problems. Identify any staff members that may need additional training. Additional staff may need to be hired to address back-logs and loss of productivity in the first few months of ICD-10 implementation.
Coding and billing activities deserve special monitoring to ensure continued productivity. In-house billing/coding departments could require additional personnel to maintain a steady workload. The alpha-numeric composition of ICD-10 coding requires billers/coders to switch between their keyboard and numeric pad. It will take extra time to complete the billing process. Any denied claims will need careful tracking to determine where documentation or coding errors may be occurring.
Auditing The Process
There are sure to be glitches along the way, even after several months of ICD-10 use. Processes and procedures throughout the practice have changed. The new codes should be audited to ensure the latest versions are being employed and communication with essential entities monitored for any undetected problems that may have crept in. Most importantly, monitor reimbursements to ensure that pre-ICD-10 implementation amounts have remained the same.
The ICD-10 changeover will be many things – exciting, expensive and frustrating. Creating an action plan will alleviate many of the potential problems. Appropriate training and education is essential and ongoing monitoring of revenues, procedures and processes will ensure a successful transition.