After much talk and maddening delays, less than 45 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:
1. 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.
2. 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.
3. 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.
4. 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.
5. 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.