ICD-10 Prep for Small Practices: 5 Ways to Get on Track

January 12, 2015

If your medical practice is among those only partially ready or just in the initial stages of an ICD-10 transition plan, it's time to get moving.

Small medical practices have felt the ripple effect of the ICD-10 delay  in different ways, depending on how close to readiness they were at the time the new date was announced.

Recently, the Workgroup for Electronic Data Interchange released findings from an ICD-10 readiness survey that demonstrated a high degree of procrastination in how actively health organizations were working toward compliance with ICD-10.

If your practice is among those only partially ready or just in the initial stages of a transition plan, here are five key tips to keep moving forward toward compliance:

1. Make sure trading partners are on track. The most important step to a smooth ICD-10 transition is to look closely at trading partners. It’s important to focus first on your biggest payers. Will they be able to support your practice after the conversion deadline? Do they have a clear transition plan with milestones that are already being met? If not, your practice needs to understand why. Achieving compliance requires a cooperative effort among entities, and any trading partner showing signs it may not meet the deadline may require your practice to seek alternative partners. What would it take (in time and money) to transition to working with these new partners should the need arise?

2. Test systems for process flow. Start testing your practice’s internal systems, such as its information management, billing, and scheduling systems. Simulate a typical patient visit to the office and send data from each step to test the viability of work flows and flush out where bottlenecks occur. Remember that with each identified disruption, there is likely a correlated negative impact on revenue that should be calculated and rolled back into the plan (see Step #5: Revisiting the plan).

3. Test with trading partners. Once your practice’s internal systems pass your tests with flying colors, conduct end-to-end testing in cooperation with your external partners. An AHIMA/eHealth Initiative survey reveals that 65 percent of organizations will be able to begin testing before the 2015 deadline; 63 percent will begin those tests this year. That’s good news for some of the industry, but your practice’s entire ecosystem will succeed or fail based on how well the collective functions together. Start by sending the most common types of test claims using ICD-10 codes. You may need to shift timelines to include the use of testing environments and the additional time that may be required to adjust to processing the test claims. If your practice has a large number of trading partners, test with the biggest ones first.

4. Survey your practice management vendor. Your practice management vendor is one of the most important pieces of the process. Review the CMS checklist of questions and the recently released list of 15 ICD-10 readiness questions. Will your PM vendor’s software require any hardware upgrades? Can its solution handle both ICD-9 and ICD-10 codes? Dual coding is important to mitigate the risks of being totally down should something go deeply wrong with using ICD-10 coding. What resources are available to help with test transactions? Review the vendor contract and examine the cost/benefit of any changes that will cost time or money.

5. Revisit the budget and implementation plan. After you take the above steps, revisit the budget and re-assess existing implementation plans. The e-Health/AHIMA survey reveals 35 percent of practices believe their revenue will go down after October 2015. Expected areas of difficulty include coding, documentation, and reimbursement.

While getting ready for ICD-10 is a massive process for a practice, the challenges are not insurmountable. Sharing and collaboration of best practices among organizations is a wise use of effort, and trading partners may already have dedicated resources to test the claims process with a variety of partners simultaneously.

Most importantly, don’t lose sight of the fact that beyond compliance, there is an industry upside to using ICD-10. The new codes are superior and in the end, it’s all about increasing the quality of care.

Michael Bearnson works in the Medical Business Solutions center of excellence at ADP AdvancedMD and has functioned as the ICD-10 project manager for the past two years.  He has over 20 years of experience with business process improvement.  Follow him on Twitter at @ICD10Posse.