How to prepare for ICD-10

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Compliance on Oct. 1 required for claims to be paid

As of Oct. 1, 2015, you will be required to start using the ICD-10 code set. On this date, you will need to start reporting patient diagnoses, as well as submitting claims using this new coding standard. Physician practices, hospitals, Medicare, Medicaid, private payers, and clearinghouses will need to start using this new code set by this critical date. Failure to do so will result in significant financial disruption because claims filed using ICD-9 after Oct. 1 will be denied as unprocessable due to invalid codes.

What does this mean for my dermatology practice?

Don’t delay; act now to avoid problems. If your practice hasn’t initiated an implementation plan, now is the time. Consider the following 10 steps to make sure your practice is fully compliant:

Step 1: Identify where the practice currently stands, and where it needs to be before Oct. 1

1. Identify where the practice currently stands, and where it needs to be before Oct. 1. Your success will depend on taking the following actions:

  • Develop a full plan to implement this critical change.
  • Educate and train the entire practice team: dermatologist(s), non-physician clinicians, medical auxiliary staff, and administrative staff.
  • Reach out and start discussing with your business partners: software vendor(s), clearinghouse, and billing service company, if applicable.
  • Start testing your software system(s) and processes with your business partners to identify potential problems with ICD-10 claim submission so they are promptly resolved.

Steps 2-4: Identify a project leader; create a budget and timelines

2. Depending on the size of the practice, identify an internal champion or project leader who has the authority to assess and manage what needs to be done to get you ready for the transition.

3. Ensure that there is a budget to cover anticipated and unexpected transition costs.

4. Assess a practice timeline by working backward from the Oct. 1 compliance deadline to develop a month-by-month plan to track progress. A suggested timeline for action is available here.

Steps 5-7: Evaluate your technology needs

5. Understand your vendors’ plans for converting to ICD-10. Determine, if and where necessary, upgrades to your EHR or practice management system (PMS) are covered by your current software license contract(s) or if there are fees associated with the conversion/upgrade.

6. Find out when to expect software upgrades. If the practice wants to consider replacing its current system to achieve ICD-10 compliance, carefully evaluate the replacement process and its cost. Will the short-term cost of replacing rather than upgrading be outweighed by longer-term productivity and business continuity gains?

7. Once the software upgrade is complete, test and verify that ICD-10-compliant claims can be transmitted successfully to the practice’s clearinghouse and payers without technical difficulties and delays. Failure to test in advance from end to end to determine readiness from snags may risk disruption in cash flow. Note that Medicare will be offering ICD-10 readiness testing March 3-7. Learn more about testing and registration in your area.

Steps 8-10: Train staff and examine claims process with clearinghouse/billing service

8. Once the proper software is in place, assess and hold training sessions, ideally when there’s sufficient downtime for staff to focus on ICD-10. Training may include updates to medical terminology, anatomy, and physiology for non-clinical staff and will need to occur on an ongoing basis so that the dermatologist(s) and practice team are sufficiently proficient and comfortable with the new coding conventions and guidelines for the ICD-10 diagnosis code set. Should the practice need additional training and reference materials, identify how to best fill those gaps.

9. Develop a comprehensive and ongoing outreach plan to all business partners — your clearinghouse, Medicare contractors, state Medicaid agency, and private payers — because your success is, in part, dependent on them. Either visit their respective websites or watch out for emails from them to ensure that they will be ready. Contact your clearinghouse and/or outside billing service to discuss requirements, changes, timing, and the effect of ICD-10 on the processing of your claims. If you don’t see progress from any of the above entities, contact them directly by phone. When checking in with payers, don’t forget to find out when their payment edits will be released. If you bill electronically, your clearinghouse may have advance information regarding these edits, so verify with them if all else fails.

10. If the practice submits paper claims, consider what printed reference resources are available to help your practice team train to become proficient. The Academy offers a coding manual, a crosswalk, and webinars/webcasts that can help.

What less obvious effects of ICD-10 should I be considering?

The ICD-10 transition will require practices to consider both direct impact and indirect implications. The transition will:

  • Require EHR/PMS software upgrades and changes to clearinghouse claims transmission for both new coding logic and definitions.
  • Require the practice to change its current paper encounter forms/superbills.
  • Require providers to change all diagnosis codes they record on any lab orders or referral requests.
  • Require providers to change their clinical documentation to support the more detailed nature of the code set.
  • Require training for staff to brush up on medical terminology, anatomy, and physiology, as well as learning and understanding the new coding conventions and guidelines.
  • Require changes to any public health reporting you perform.
  • Require potential technical modifications to payer contracts and fee schedules.