All healthcare providers should be aware that next year, ICD-10 billing codes replace ICD-9 codes for all HIPAA covered entities. Any claims for services provided on or after October 1 that do not use ICD-10 will be rejected. Hopefully, you are already preparing your medical practice for using the new codes.
The Center for Medicare and Medicaid Services (CMS) offers transition preparation checklists that are comprehensive. You choose a checklist depending on whether you are a hospital, small medical practice or large group practice. Other health-related organizations offer their own checklists. They are all similar but have varying suggestions.
The first step on all checklists for all medical practices, whether a general practice, orthopedic or radiology practice, is to designate one person on your staff to be in charge of the implementation plan. That person should assemble a team so that more than one person knows what needs to be done at each stage of the plan and who is in charge of which tasks. Here is a simplified checklist the person in charge can use.
- Identify when and where ICD-9 codes are currently being used in your practice. Ask all staff members for their input.
- This includes all the medical records, bills for compensation, vendor contracts and clinical documentation of services.
- Identify the staff member responsible for each ICD-9 paperwork process.
- Review the many ICD-10 resources available from CMS as well as HIPAA, your vendors and payers.
- Obtain pertinent information of your practice management systems vendor such as will the system accommodate ICD-10 codes or will upgrades be needed?
- If upgrades are needed, will there be a charge for this service?
- When will the upgrades be completed?
- When will they be ready for testing?
- If you outsource your billing, be certain your service is upgrading their systems.
- Determine when upgrades will be available for you to test the system.
- Check with your payers about their systems upgrades and availability for testing.
- Review your payer contracts and determine whether new ones will be required.
- Identify any changes in payer contracts, particularly if there will be any added charges or fees.
- Determine training needs of your staff.
- Training in new ICD-10 codes
- Training on any software upgrades or new systems
- Training on any necessary changes in workflow
- Implement specific training protocols for use of ICD-10.
- Determine the ICD-10 codes that will be used most frequently in your practice. Concentrate training on those.
- Establish a budget for implementation.
- Cost of any system upgrades
- Staff training and continuing education requirements
- How to deal with a delay in reimbursement
- Schedule testing with your any entity that receives claims, bills or reports from your practice. There will be competition for testing times since medical practices across the country will be vying for testing time.
- Evaluate all systems and implement error correction if necessary.
Begin compliance on October 1, 2015.
For more specific guidance and support in the revenue cycle management aspect of the ICD-10 conversion process, please feel free to contact Health Information Services (HIS). We would be happy to help.