Status on ICD-10 Implementation [Infographic]

September 9th, 2015 - Adam Smith   
Categories:   Diagnosis Coding  
0 Votes - Sign in to vote or comment.

We will be using ICD-10 in a few weeks. But before that do you know the status on ICD-10 implementation?Do you know how the ICD-10 will impact your practice's revenue

What changes can happen?

  1. Claim Errors will Increase
  2. A/R Could Rise
  3. Rise in Claim Denial Rates
  4. Physicians Documentation Concerns

Status on ICD-10 Implementation

2015 survey was intended only for healthcare providers. Sixty percent responded on behalf of a hospital or health system

  • According to the survey, just 7% of physicians said they have started transitioning to ICD-10 extensively.
  • 31% of respondents said they had not started the transition at all.
  • Among solo physicians, 82% said they have not started the transition at all or have made only limited
  • 42% of respondents said they are “not at all confident” that the implementation of ICD-10 will cause no serious disruptions.
  • 83% of respondents expect the transition to result in delayed or denied claims;
  • 36% expect to face disruptions that require them to draw from personal funds;
  • 32% said they might reduce staff size, work hours or benefits; and
  • 30% said they might retire early because of anticipated cash-flow issues related to the transition
  • 65% said they are capable of processing ICD-10 codes;
  • 52% said their practice management software was capable of processing ICD-10 codes
  • 1% said they will need to completely replace their IT systems to comply with ICD-10.

A recent survey of 1,100 organizations found:

#More than half of respondents were uncertain of the actual ICD-10 deadline
#And more than half had not yet completed end-to-end testing.

#Some providers still believe the switch to ICD-10 isn’t going to happen this year.

“This is an off-election year, and if I was a politician, I would roll ICD-10 out during an off-election year rather than delay it,” says Mr. Joshua Berman, RelayHealth ICD-10 Director.

Provider organizations that haven’t adequately prepared for the switch are going to have issues with the processes that ICD-10 requires.
However even organizations that have prepared may still have problems.

This isn’t a technology change, it’s a process change

The switch to ICD-10 requires coding staff, physicians and all others who document conditions to be properly trained to ensure billing is done correctly.

All providers are likely to encounter some issues with the switch to ICD-10, including an increase in claim denials and the amount of time it takes payers to process claims

For small practices Road to 10 from CMS has primer for clinical documentation, clinical scenarios, and other specialty-specific resources to help with implementation.
Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of services after September 30, 2015

6 foundations for ICD-10 implementation you can’t ignore!

  • ICD-10 CM/PCS Communication
  • Coding Education
  • Clinical Documentation Initiatives
  • IT Plan
  • Revenue Cycle Plan
  • Post “Go Live” Health Information Management & coding activities

1 Communication:

  1. A) Concise Messaging
  • Vision Statement
  • Partners & Roles
  • Timelines
  • Defined Methods of Communication

ICD-10 CMS/PCS Vision Statement

Clarity-steering the team in the right direction

Inspiring and meaningful versus compliance driven

Expected outcomes-how we will be working differently following ICD-10 implementation

Partners and Roles

  • Identify
  • Internal groups
  • External groups (Partners)
  • Agreed upon communications

Have a timeline that outlines milestones, secondary tasks and deadlines keep implementation teams on task.

Multiple communication methods should be used

Thumb of rule says, “seven times, seven ways”

2 Coding Education:

Self assessment goals checklists

Rate your self on a scale 1(Goal not accomplished at all) to 5(Goal accomplished)

  • Are you aware of your foundational knowledge strengths related to A&P, disease processes, pharmacology, etc.?
  • Are you completing tasks to improve your weaknesses related to A&P, disease processes, pharmacology, etc.?
  • Are you networking with a subject matter expert and peers?
  • Are you practicing and applying codes to “real world” documentation?
  • Are you working to understand the ICD-10-CM/PCS coding guidelines?
  • Are you gaining a deeper understanding of the clinical documentation improvement protocols?
  • Do you work collaboratively with clinical documentation specialists when a clarification or query is needed?
  1. Clinical Documentation Improvement

The success for this includes

#physician involvement

#communicating documentation gaps

#Other key data findings

Which agree upon goals of a CDI improvement process and ongoing focused reviews with feedback.

Medical staff, CDI staff & the coding staff will need education on the findings from documentation reviews

Findings should include discussion of the documentation elements needed to support ICD-10 codes through use of specific examples.

The value of more concise data capture for high quality data should be emphasized.

4. IT Block

For the most part, IT plans for the transition to ICD-10 are well underway, due in part to the conversion to 5010 compliance.

Important elements of the IT building block for ICD-10 readiness to be monitored throughout the implementation include.

  • Communications to and from vendors
  • Testing of system capabilities
  • The costs associated with IT implementations
  • Necessary upgrades and system maintenance.
  • Decisions around how ICD-9 and ICD-10 databases will be accessed and maintained will need to be made.

5.Revenue Cycle Block.

The 9 pieces of advice from Government Health IT practices must consider

  • Practices should develop a budget and strategy to provide for additional cash reserves should delays in payment occur.
  • Practices should conduct financial modeling to understand the impacts of moving from ICD 9 to ICD 10 – the impacts should be looked at by provider, by facility, by service line, and by geography if applicable.
  • Managed care contracts should be reviewed and if necessary, renegotiated to decrease negative impacts to the bottom line.
  • The readiness of high volume payers should be assessed to determine their ability to process claims. Many payers are now posting readiness information on their web sites.
  • Conduct CDI reviews using ICD 10 code sets to determine if documentation contains the specificity necessary for ICD 10.
  • The potential for backlogs in medical coding, billing, and claim edits should be analyzed and a strategy developed to work the backlogs.
  • A strategy for pre and post ICD 10 denials management should be developed.
  • Assess the readiness of external vendors who support coding, billing, follow up and denials.
  • Any audits currently performed (compliance, RAC, etc.) should be reviewed to determine ICD 10 impact.

6.Post Go Live HIM/Coding Activities.

Most important block for ICD-10 implementation is to plan the activities to undertake following the deadline. As Sir Walter Scott said, “I can give you a six-word formula for success: Think things through – then follow through”

  • Practices must follow through and monitor coding accuracy and productivity following go live.
  • When problems are identified, strategies should be implemented to address workflow problems, process problems, and resource issues.
  • Determine if further education and training is needed and provide it expeditiously to prevent future issues.
  • Monitor for opportunities to improve data integrity through EHR enhancements, monitoring of alerts, and communication with physicians & clinical documentation improvement staff.
  • Finally, monitor productivity to manage responding to staffing needs.
  • Go live will be a challenging time for all and retention of highly trained, skilled coding staff will be essential.

Which of these building blocks needs more attention in your organization? Vs Which has been successful?

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Emergency Department - APC Reimbursement Method
September 15th, 2022 - Christine Woolstenhulme, CPC, CMRS, QCC, QMCS
CMS pays emergency department visits through a payment method using Ambulatory Payment Classifications (APCs). Most payers also use the APC reimbursement system; however, there may be some differences in payer policies (always review your specific payer policy). APCs are the primary type of payment made under the OPPS, comprising groupings ...
Why Medical Coding and Billing Software Desperately Needs AI
September 7th, 2022 - Find-A-Code
It has been said that the healthcare industry is notoriously slow in terms of technology adoption. One need only look at how convoluted medical coding and billing are to know that it needs a technology injection. Specifically, medical coding and billing software desperately needs artificial intelligence (AI).
CMS says Less Paperwork for DME Suppliers after Jan 2023!
August 18th, 2022 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Attention providers, suppliers, billers, and vendors who bill Durable Medical Equipment (DME) to Medicare!  Currently, a supplier receives a signed Certificate of Medical Necessity (CMN) from the treating physician or creates and signs a DME Information Form (DIFs); these are required to be sent with the claim. However, this is about ...
Things to Consider Before Upgrading Medical Billing Software
August 11th, 2022 - Find-A-Code
Your practice has utilized the same medical billing software for years. The medical billing staff says it is time for a change. You don't necessarily disagree, but you also don't know where to begin your search for new software. There are so many vendors offering so many products that making sense of it all can be challenging.
Calendar Year 2023 Medicare Advantage and Part C & D Payment Policies
August 9th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Each year CMS publishes an Advance Notice of the upcoming years Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies and asks for comments related to it. Each of the comments are carefully reviewed and responded to and often are impactful to changes seen between the Advance Notice and final publication referred to as the Rate Announcement. With health equity as a primary focus for 2023, CMS announced some policy changes that may impact your organization.
How CMS Determines Which Telehealth Services are Risk Adjustable
August 9th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Medicare Advantage Organizations (MAOs) have gone back and forth on whether or not to use data collected from telehealth, virtual Care, and telephone (audio-only) encounters with Medicare beneficiaries for risk adjustment reporting, but the following published documents from CMS cleared that up once and for all by providing an answer to a question specifically related to this question.
OIG Investigates SCAN Health for Risk Adjustment Overpayments With Surprising Results
July 26th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
We’ve seen a number of OIG risk adjustment data validation (RADV) audits recently where the independent review contractor was simply looking for any codes the payer reported that were not supported by the documentation, in an effort to declare an overpayment was made and monies are due to be repaid. However, it was refreshing to read this RADV audit and discover that the independent review contractor actually identified HCCs the payer failed to report that, while still resulting in an overpayment, was able to reduce the overpayment by giving credit for these additional HCCs. What lessons are you learning from reading these RADV audit reports?



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2022 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association