[ By Avery Hurt, December 2015 | See original page ]
The ICD-10 transition will continue into the next year for practices. Here are some tips you’ll need to take in 2016.
ICD-10 has gone pretty smoothly so far, but savvy practices are planning their ICD-10 goals for 2016. Fletcher Lance, vice president and national healthcare leader at consulting firm North Highland, pointed out that while some of what we were worried about in the lead-up to the ICD-10 transition did come true (a 25-30 percent drop in coder productivity, for example), some didn’t (so far, only a roughly 2-4 percent increase in denials). “Everyone, understandably, has breathed a sigh of relief, but it’s not time to take your hand off the wheel,” said Lance. We can expect denials to continue to increase—even if gradually—as payers tighten up on specificity requirements. Lance also pointed out that there are still a lot of claims in the system that haven’t made the loop yet.
Elizabeth Woodcock, president of Woodcock and Associates, an Atlanta-based physician practice consulting firm, agreed. “My concern is that right now payers are adjudicating pretty much everything that makes sense. When they start tightening up in the next 9-18 months, then we’ll start to feel the squeeze.” Practices shouldn’t expect a “tsunami of denials,” said Lance, but something more like “denial creep.” Nonetheless it is something practices ignore at their peril. Woodcock expects that the tightening will first occur in the area of pre-authorizations and pre-certification requirements.
It’s not just getting the codes right that practices need to be preparing for in 2016. “Once enough data is collected,” said Tammie Olson of Management Resource Group, a firm offering financial management and support services for the healthcare community, “payment policies are likely to change. Conditions that were covered before may not be covered any longer.” If you want ICD-10 to go at least as smoothly in 2016 as it as so far, here are a few steps you need to take:
* Make sure you have the financial cushion to cover a potential increase in denials—especially if your coding isn’t totally up to par and you’ve been counting on leniency from payers.
* Track denials and work them in a timely manner.
* Continue to train coders — advanced classes and classes for specialties are available. Address any drop in coder productivity.
* Woodcock recommends designating one biller who sets aside a few hours each month to check for policy changes on the websites of every major payer. Changes will be posted on websites, and if you don’t look for them, you won’t know about them.
“Remember that ICD-10 may have been implemented Oct. 1, 2015, but the impact will continue,” said Olson. “Just because things have been smooth so far doesn’t mean that changes aren’t going to come in the future.” On the other hand, Lance sees plenty of reason to be optimistic. “Sometime in the next year or so, we’ll start to see how we can use this data for better patient outcomes.” And that’s why we did all this, wasn’t it?
• Denial reasons
• Deviations in coding and claim types
• Staff productivity
• Payer performance
• Is revenue and/or diagnoses changes related to ICD-10 coding or changes in patient case mix?
• Billing staff productivity. Are new processes or staffing changes impeding productivity?
• Claims denial rates. Are your denials the result of payer errors, billing staff errors, or medical necessity edits?
• Payment turnaround times. Are payers experiencing payment backlogs?
• Reimbursement. Is your organization receiving the full amount of reimbursement that it is entitled to?
With less than 30 days until the ICD-10 deadline, physician practices better be ready to use ICD-10 codes. If not, get started.
With that timetable in mind, I cribbed and put into a post the Centers for Medicare and Medicaid Services (CMS) ABCs of ICD-10 preparation. There are three parts to it:
- Assess how ICD-10 will affect your practice and make a plan
- Be sure your systems are ready
- Contact your vendors
Considering I’ve been blogging about this for four years, that doesn’t seem like a lot of work. Denny Flint, a healthcare consultant, sees advice like this as too much work. Not that he’s against hard work, but there isn’t enough time to do a lot of ICD-10 project planning. So he strips it down to clinical documentation training.
Even that is pretty easy in his opinion. Start dual coding patient encounters. He calls it a silver bullet. Dual coding will show where documentation falls short and give the coding staff practice with the ICD-10 code set.
Rosemarie Nelson suggests a similar quick path to ICD-10 implementation but points out something that needs to be added to Flint’s advice: Focus on the most common diagnoses.
Flint also recommends dual coding at least 10 patient encounters each week. Make sure the most common diagnoses are part of that mix. If you don’t have a practice management system that can run a report of common diagnoses or ICD-9 codes, the look at the superbill. Go by instinct or memory. But start coding something.
The MLN Connects Provider eNews for Sept. 3 provided links to several ICD-10 resources:
- Access the ICD-10 Code Set
- List of Valid ICD-10-CM Codes
- “General Equivalence Mappings Frequently Asked Questions” Booklet — Revised
- “ICD-10-CM/PCS ICD-10-CM/PCS Myths and Facts” Fact Sheet — Revised
- “ICD-10-CM Classification Enhancements” Fact Sheet — Revised
- “ICD-10-CM/PCS The Next Generation of Coding” Fact Sheet — Revised
- Get Ready Now: Assess How ICD-10 Will Affect Your Practice
- Prepare for ICD-10 with MLN Connects Videos
(Centers for Medicare and Medicaid Services)
- Contact your vendors
- Train your staff
- Convert your top 10-15 diagnoses to ICD-10 codes
- Prepare to watch acknowledgement reports
- Reserve cash
- Medical coder training
- Physician training
- Convert forms and templates to ICD-10 codes
- Test with payers
- Clean up your billing back logs
- Automation can boost productivity
Looks at a survey by Porter Research in August and commissioned by Navicure:
- 85 percent were optimistic they would be ready Oct. 1.
- At the time of the survey, 57 percent said they were ready.
- Thus, the “shaky optimism”
- Note, other surveys found much less readiness among smaller healthcare providers.
- Healthcare providers worry about:
- Cash flow
- Staff morale
- Clinical documentation
- Patient experience
- Staff productivity
- Breast cancer: Document where cancer appears in the breast and which one (left or right).
- Benign neoplasm of the colon, rectum, anus, and anal canal: Be specific about where in the colon it occurs.
- Sickle cell anemia: This is now a combination code.
- Primary liver cancer: Specify the type of liver cancer.
- Lymphoma: There will be many types of lymphoma to document as well as anatomical location.
- Malignancy in pregnancy: Coding goes beyond the neoplasm chapter. For example, you will need to document trimester.
I don’t usually recommend webinars but I thought one on last minute ICD-10 tips scheduled for Sept. 22 is aptly named. (Daily Practice Blog)
- CureMD unwrapped a free training tool for physicians.
- NueMD posted ICD-10 tools that include a code-search function and training games.
- ICD-10 Charts posted free online services for converting from ICD-9 to ICD-10 and building charts with ICD-10 codes.
- 3M Health Information Systems updated its cloud-based Code Translation Tool for converting ICD-9, CPT or HCPCS codes into ICD-10 as well as normalizing reports, updating processes and educating staff.
Grab a cup of coffee before you get into this financial analysis of how ICD-10 coding will affect MS-DRG reimbursements. The bottom line is that reimbursements will drop less than 1 percent after Oct. 1. (3M HIS Blog)
After much talk and maddening delays, less than 21 days remain before ICD-10 takes effect.
Over the past year, medical groups and individual physicians have been working — some methodically, some scrambling — to get ready. Staff has been trained, technology has been upgraded, myths have been dispelled, and practice runs have taken place. But now is no time to take your foot off the accelerator: The stakes are simply too high.
As physicians head into the final home stretch, here are five things to do between now and September 30 to help ensure a successful transition to ICD-10:
- Remember the changes brought about by ICD-10 will have an impact on everything within the medical office. Don’t fall into the trap of being too limited in who you train or in underestimating its implications. Make sure you have trained the front-office staff; clinical staff; billers and coders; and, of course, physicians. So, too, remember that everyone will need to use ICD-10 codes for any procedures performed on or after Oct. 1. You won’t get paid for any claims of services if you continue to use ICD-9 codes.
- By now, you should have compiled a list of your practice’s 50 to100 most common ICD-9 codes and mapped them to their, often numerous, equivalents in ICD-10. You should have also started working with the codes to become familiar with them and thus avoid the stress of learning new code structures after ICD-10 has taken effect and your cash flow is directly impacted. If you haven’t done so already, now is your last chance to test not only the knowledge of your office staff, but the technology you have in place to make sure it can generate a claim, perform eligibility and benefits verification, schedule an office visit, schedule an outpatient procedure, update a patients history, and code a patient encounter. Test, test, and test again.
- These final days are your last chance to make sure your vendors and health plans are just as prepared as you are. Talk with any software vendors, clearinghouses, or billing services you use to be sure they are ready to provide the support you need and then test your system with partners you work with most often. Remember, ICD-10 means much higher data-management demands thanks to larger procedure and diagnosis code sets, so it is not only critical to make sure your own practice management software can handle this changeover, but your vendors’ staff and IT systems can handle this increased capacity as well.
- If you don’t feel fully confident you will be ready on Oct. 1, there are a few things you can do. First, take advantage of the free events and training sessions offered by CMS to help practices prepare for ICD-10. Check the CMS events calendar for details. Medical societies and healthcare professional organizations are also great resources for knowledge and support. So, too, turn to vendors you trust to be your partner in navigating your way through this conversion. Second, explore alternative ways to submit claims to health plans if you feel your systems won’t be ready for the changeover. For Medicare providers, options might include free billing software or even paper claims for providers who meet the Administrative Simplification Compliance Act Waiver. Third, you may want to consider securing an additional line of credit to ease the impact of delayed payments on cash flow and operations.
- The most important thing you can do is keep your cool. Change of any kind, even good change, carries with it a certain amount of anxiety. Even for those practices best prepared, this conversion will be complicated and at times frustrating. After all, the move to ICD-10 will drastically impact how physicians around the country are paid as well as how the care they provide to their patients gets captured and reported. ICD-10 includes more than 68,000 diagnostic codes, compared to 13,000 in ICD-9 while including twice as many categories and alphanumeric classifications for the first time. The new codes include fundamental differences such as changes in terminology and a greater level of diagnosis detail to appropriately reflect advances in medical knowledge. These are some of the most important transformations ever in the healthcare industry. The degree and complexity of these changes underscores the need for physician groups to have the right tools, knowledge, people, and foresight in place … but it also should remind you to be thoughtful and supportive of those in your office working hard to meet this challenge.
Date: July 24, 2015 | By: Mary Jean Sage
Here are 11 tips to ensure your practice will be on track for a successful ICD-10 transition come Oct. 1, 2015 and beyond.
The deadline for implementing ICD-10 is rapidly approaching. Providers and practices should be preparing for the transition and approaching the implementation with confidence. They should be doing this even with the recent announcement from CMS on creating a one-year grace period, allowing for flexibility in the claims auditing and quality reporting process during the transition. Addressing the following 11 steps will help assure your practice will be on track for a successful transition on Oct. 1, 2015 and going forward:
- UNDERSTAND ICD-10
Review the major differences between ICD-9 and ICD-10 and how those differences will affect a clinician’s specialty as well as your organization as a whole. Reviewing the “Official Guidelines for Coding and Reporting” for ICD-10 is a good starting point.
- CREATE YOUR INTERNAL IMPLEMENTATION AND COMMUNICATION TEAM
Include staff from the administrative and clinical sides of your practice and divide up the work that needs to be accomplished. Make sure you communicate the changes required by ICD-10, both from a workflow standpoint as well as clinical documentation.
- REVIEW THE IMPACT AREAS OF YOUR PRACTICE AND MODIFY PROCESSES
Consider all the different systems you use, the organizations you exchange data with, as well as what electronic and paper-based workflow processes you use that drive clinical encounters and the billing process. Make sure all of these are updated and/or modified appropriately for ICD-10 compatibility.
- REACH OUT TO YOUR SOFTWARE VENDORS
Ask vendors about any needed upgrades to use ICD-10, what training (if any) will be needed, and cost estimates. Don’t forget to ask about the ability to concurrently use ICD-9 and ICD-10 and how long you’ll have the ability to do that.
- DEVELOP YOUR BUDGET
Make sure you consider software and hardware upgrades, education and training costs, the cost of temporary staff during transition should it be needed, changes to printed materials, additional time for documentation review, and the cost of lost coder, clinical and/or revenue cycle staff productivity.
- CONTACT YOUR CLEARINGHOUSES AND HEALTH PLANS
Ask if all their upgrades to accommodate ICD-10 have been completed and if they haven’t, when they will be. Also ask how they (the clearinghouse and health plans) will help your practice with the transition, when can you test claims and other transitions with ICD-10 codes, and whether they provide a list of any data content changes needed. Don’t forget to ask the health plans when they expect to announce their revised ICD-10-related coverage/payment changes.
- IMPROVE CLINICAL DOCUMENTATION
This may be one of the most challenging aspects of ICD-10. Identify potential documentation issues by beginning to crosswalk ICD-9 codes to ICD-10 codes. The goal should be to identify any gaps in the documentation that prevent a coder from selecting the appropriate ICD-10 code.
- TRAIN YOUR STAFF
Identify your education needs. While everyone will need to be trained, not everyone will need to be trained at the same level. Identify who should be trained on what. You will also need to identify the best training mode for each group and the timeframe for providing that training.
- TEST YOUR SYSTEMS
Testing is critical to success with implementation. Plan for both internal and external testing. This will need to be scheduled, so begin the planning now.
- PLAN FOR CONTINGENCIES
Every practice needs to plan for decreased staff productivity and prepare for the possibilities of other financial challenges during the initial implementation period. You should set aside some cash reserves for the practice. It may also be wise to consider establishing a line of credit.
Preparing now for the transition to ICD-10 will help ease the burden of compliance on Oct. 1, 2015 and assure you will not have a major disruption in your practice revenue.
- UNDERSTAND THE ICD-10 GRACE PERIOD
Make sure you familiarize yourself with the new grace period rules, including some key points below. CMS also announced the establishment of a communication center and an ICD-10 ombudsman to help receive and triage physician and provider issues.
Medicare contractors will not deny claims based solely on the specificity of the ICD-10 diagnosis code as long as a valid code from the right family of ICD-10 codes is used. Moreover, physicians will not be subject to audits as a result of ICD-10 coding mistakes during this one-year period.
Physicians will not be penalized under the various CMS quality reporting programs for errors related to the additional specificity of the ICD-10 codes, again as long as a valid ICD-10 code from the right family of codes is used.
If Medicare contractors are unable to process claims within established time limits because of ICD-10 administrative problems, such as contractor system malfunction or implementation problems, CMS may in some cases authorize advance payments to physicians.