Transition Planning

Establishing a cross-functional team with duties to include: planning, testing and training across functional areas; meeting with software vendors to understand their efforts toward easing the transition, determining how to work with vendor systems to support an automated process whereby charges entered after certain service dates are forced to utilize ICD-10; discussing timelines for upgrading software to new coding systems; adequate testing before the deadline; reviewing existing contracts for potential impact on coverage changes; conducting a potential financial-impact assessment of ICD-10 from a reimbursement perspective; reviewing documentation impact; and planning targeted training programs relevant to each functional area are some of the important steps that needed to be accomplished to move forward to ICD-10 implementation.

Staff Education

  • raining the staff is the core issue for the ICD-10 Implementation
  • Identify the Staff for the Training
  • Select the Lead from the team for the Trainer Position
  • Identify and Document the clinic workflow
  • Understand the areas that need to be paid more attention
  • Identify the extent of training required for the staff
  • Plan for role based training

Medical Record Documentation

The major impact of ICD-10 is on the medical documentation front. As the number of codes has increased, there is need for greater specificity in the documentation for the appropriate reimbursement.

  • Identify the method of current documentation. Documentation may be through the EMRs, transcription, scribbling, palm-held computers, etc.
  • Pick random files and review the documentation
  • Pick procedures (ultrasound scan, x-ray, etc) and analyze the documentation
  • Identify the gaps
  • Document the lack of specificity issues
  • Document the most common ICD codes for the speciality
  • Discuss with physician and explain the specificity of the codes
  • Prepare some sample documentation guidelines
  • Providers need to undergo training on how to document as per the ICD-10 codes

IT

As such the up gradation of hardware is not required, but one will need to upgrade the medical billing software and EMR.

On January 1, 2012, standards for electronic health care transactions change from Version 4010/4010A1 to Version 5010. These electronic health care transactions include functions like claims, eligibility inquiries, and remittance advices. Unlike the current Version 4010/4010A1, Version 5010 accommodates the ICD-10 codes, and must be in place first before the changeover to ICD-10. The Version 5010 change occurs well before the ICD-10 implementation date to allow adequate Version 5010 testing and implementation time.

If providers do not conduct electronic health transactions using Version 5010 as of January 1, 2012, delays in claim reimbursement may result. If health plans cannot accept Version 5010 transactions from providers, they may experience a large increase in provider customer service inquiries affecting their operations.

Identify the vendors who can support the ICD10 in the following areas

  • Version 5010 to submit the claims
  • Incorporating ICD10 codes in EMR
  • Documentation guidelines

Reimbursement

ICD-10 codes must be used on all HIPAA transactions, including outpatient claims with dates of service, and inpatient claims with dates of discharge on and after October 1, 2015. Otherwise, claims and other transactions may be rejected, and you will need to re-submit them with the ICD-10 codes. This could result in delays and may impact your receivables.

This change does not affect CPT coding for outpatient procedures.

Reimbursement based on the procedure codes, even though the CPT codes are not going to change, the payment depends up on the Medical Necessity, Matching the CPT to ICD-10 codes appropriately.