MGMA’s Tennant Offers Practices Prep Tips for ICD-10, HIPAA 5010

October 26, 2011

Upgrading to 5010 is just the beginning of what practices need to do to prepare for ICD-10, which will require dozens of hours of training and preparation, in addition to substantial financial resources.

If you’re like many of the physician practices attending this year’s MGMA11 Conference in Las Vegas, you’ve barely wrapped your brain around the magnitude of changes required to switch to ICD-10. 

And the first of these, upgrading HIPAA Version 5010, is just two months away.

Swapping 4010 software for 5010 is just the beginning of what practices need to do to prepare for ICD-10, which will require dozens of hours of training and preparation, in addition to substantial financial resources.

During the session “ICD-10 and New HIPAA 5010 Transaction Standards,” Robert Tennant, senior policy adviser of government affairs for the Medical Group Management Association (MGMA), aimed to bring physicians up to speed.

The first to-do item for practices that haven’t done so already: Making the switch to 5010, which isn’t as easy as flipping a switch. This not only means upgrading your practice management system with necessary software, but testing claims processing with your vendors and business partners.

The biggest consequence of not being ready to transmit 5010 claims by the Jan. 1, 2012, deadline imposed by The Centers for Medicare and Medicaid Services (CMS) is an influx of claim rejections. Yet recently, 70.4 percent of practices interviewed by MGMA said their practice has not prepared an impact analysis describing how HIPAA Version 5010 will be handled.

And when asked about their scheduled date to begin HIPAA Version 5010 internal testing, 24.3 percent said they hadn’t yet scheduled it.

“This is not going away,” said Tennant. “This date is not going to move. You have to run on the assumption that CMS is full steam ahead.”

Transitioning to ICD-10 by Oct. 1, 2013, though two years away, will be an even more overwhelming change for practices, said Tennant.

Providers, billers, and coders will have to learn to use seven-digit alphanumeric codes, which are more specific than their predecessor three- to five-numeral ICD-9 codes. The upshot, said Tennant, is providers will need to spend more time with patients and documentation. The American Academy of Professional Coders (AAPC) estimates a 15 percent increase in documentation time, he noted.

Tennant offered the example of a patient who fractures his left wrist, and then a month later, fractures his right wrist. Today, a payer might flag a practice for double billing. But with ICD-10 “there is laterality, left and right,” among other considerations, such as how the fracture occurred.

Another example: Under ICD-9, there are four codes for a sprained ankle. “Under ICD-10, there’s 72 codes,” Tennant said.

During his presentation, Tennant cracked a couple of jokes on some of the seemingly arcane codes, noting that one code, V91.07XA, involves a “burn due to water skis on fire."

“You’ll be amazed at the codes in there,” said Tennant. “That increased granularity is going to cause a headache and additional documentation requirements … I would argue it’s the biggest change to healthcare since Lyndon Johnson signed the Medicare Bill in the 1960s.”

For a typical small physician practice of three physicians, the cost of conversion to ICD-10 is estimated to be $83,290, according to MGMA figures.

So, what are your practice’s action steps? Here is some of the advice Tennant offered attendees:

Don’t sit back and expect your vendor will solve all of your problems. “You only have two months to go for the 5010 compliance date,” said Tennant. “You need to be well aware it’s your practice income on the line.”
Ask the right Internal questions. Tennant said these include: “when do we organize a plan?” “How can I minimize the negative impact of this on my organization?” And “who needs to be involved in the decision-making and the day-to-day logistics of the project?”
Do an impact analysis. Practices should look at their practice infrastructure, computer systems, processes, information management, and health plan revenue, said Tennant, suggesting creating a spreadsheet to track progress.
Determine if your current practice management software can generate the 5010 transactions. “Practices scramble at the last minute because they figure, ‘oh, I’ll get an upgrade from the vendor,’” said Tennant, who suggested practices ask their vendors, “if I upgrade my software, is it going to require any new hardware?”
Don’t train too early. “If you send your physician to train next week, they will have forgotten everything by 2013.” Tennant said current industry recommendations are that professional coders need to train 9- to 12 months before the codes go live, and clinical staff train six months in advanced.

Gina Hayes, business manager for Orthopedic Specialists of the Carolinas, a 42-provider practice based in Winston-Salem, N.C., who attended the MGMA11 conference, said her practice already has an ICD-10 Committee in place.

“Providers are used to coding to the fifth specificity, so it’s going to be very cumbersome,” said Hayes. “I think some practices think, ‘If I do this a couple of months in advance, my providers will be okay.’ You need to get started now.”