The ICD-10 implementation deadline was extended to at least October 1, 2015 by healthcare law H.R. 4302, effective April 1, 2014. Although ICD-10 is delayed, you are encouraged to continue conversion training plans to ensure your staff and payers are prepared for the new deadline.
The deadline for the U.S. healthcare industry to convert from ICD-9 to ICD-10 codes is at the earliest October 1, 2015. ICD-10 is the tenth revision of the International Classification of Diseases, a classification list maintained by the World Health Organization. The transition to ICD-10 is possibly the largest industry change current healthcare professionals will experience in their lifetime.
Healthcare professionals and insurance payers will move from using approximately 13,000 codes with ICD-9 to nearly 70,000 with ICD-10. Furthermore, ICD-10 will have three to seven digit alphanumeric codes, as opposed to ICD-9’s three to five digit codes that are mostly numeric.1 The driving force behind ICD-10 is that ICD-9 simply cannot accommodate new diseases and procedures. In addition, ICD-10 will improve the ability to track disease patterns more specifically and prevent healthcare fraud—as ICD-10 contains an increased level of detail.
Over 20 international countries have already converted to using ICD-10 for reimbursement in their health systems—and over 100 countries use ICD-10 for human death reporting. According to the U.S. Department of Health and Human Services (HHS), all HIPAA-covered entities must comply with ICD-10 by the set deadline. The wide-spread impact of ICD-10 to healthcare—including urgent cares—will be noticeable. There will be permanent shifts in operational workflow and overall revenue reimbursement.
What can you do to get ready for ICD-10? Rather than waiting until the transition date, start preparing now. In fact, the hope is that your urgent care has already been preparing. Immediate transitions are rough. But if you begin planning and training in advance, the switch will be a natural progression rather than a sudden jolt to your practice.
Depending on your practice, ICD-10 may affect you differently than others in the industry.Your staff may use certain codes frequently, and other codes not at all. (Note: Workers’ compensation and auto insurance companies are not covered by HIPAA and may choose to keep using ICD-9.) Create a list of needs specific to your staff and their roles—including everyone impacted. Construct an educational approach accordingly.
Offer educational resources
The education of your clinical staff is in your power. Offer educational materials and resources so your staff can become familiar with changes. Decide on an implementation plan and incorporate code set training within it. Webinars, training sessions, and reading material from industry organizations will help your staff prepare. Set a training calendar for pre-ICD-10 and evaluations for post-ICD-10.
Prepare staff mentally
Leaders within your clinic should reframe ICD-10 as an opportunity to learn and improve patient documentation—employees will follow their example. While resisting change is a natural reaction, the more your staff is ready in their minds for the code switch, the better they will accept it. Consistent, frequent training is the best way to instill confidence and promote mental acceptance.
Map code equivalents—and limitations
Nearly 75% of ICD-9 codes are either an exact or approximate match in the ICD-10 code set.2 While your EMR can help map equivalent codes, there is a small portion of ICD-9 codes that will not have a close ICD-10 match. Map the codes that are used most frequently in your clinic. Finally, ensure providers understand specific documentation will be crucial to choosing the correct code for billing.
Practice new documentation skills
Over 1/3 of ICD-10 codes are similar to existing ICD-9 codes; they simply add laterality specifics (such as on the right or left side of the body).3 Schedule practice sessions with staff matching old versus new codes using a specific diagnosis. Your EMR vendor should allow you to practice with ICD-10 codes before the transition date.
Prepare for workflow changes
Provider productivity is expected to drop when ICD-10 is implemented, as they’ll need to be more specific in both their documentation and diagnosis. The superbill will no longer be an effective or practical help for coding purposes. Billers will need to strengthen their knowledge of anatomy and physiology terminology. In addition, code choices could dramatically impact revenue.
Resource: The Centers for Medicare and Medicaid Services has a section on their website dedicated to ICD-10.
Ask about transition timelines
Are your payers ready for ICD-10? Strengthen your relationship with insurance companies and keep the lines of communication wide open before the transition date. Ask for continuous updates on transition progress and how the payers are planning to accomplish the switch. Check into what type of testing is planned—and what their back-up plans are in case things go wrong.
Know payers’ plan for code acceptance
There’s no magic switch to flip on October 1. Both ICD-9 and ICD-10 codes will need to be used in parallel by payers. Get your payers’ policies for dual code acceptance and planned cut off dates. Also check with your EMR vendor to see their timeline for dual code support.
Be ready for reimbursement delays
The industry expects that ICD-10 will result in reimbursement delays. Payers will be faced with ensuring code accuracy on claims submissions, even with clearinghouses’ help. Depending on payer readiness, your reimbursements could experience noticeable delays after the transition date.
Recommendation: Examine your cash flow and have at least three months of extra cash on hand when the deadline hits.
Check into your biller’s recertification plan
ICD-10 requires billers and coders to become re-certified in the new code set. Whether you do billing in house or have an outside billing service, it’s in your urgent care’s best interest to be aware of your biller’s plans for switching to ICD-10. Billers should have a training plan in place, which includes Anatomy & Physiology training, code set training, and assessments. (note: All AAPC certified coders have two years to take the required ICD-10 Proficiency Assessment beginning October 1, 2013 and ending September 30, 2015.)4
Review clearinghouse claim submission checks
Clearinghouses will play a critical role between urgent cares and payers. Running reports on common errors such as most denied claims by ICD-9 codes, most denied claims by payer, and most frequently used codes by your providers will help you prepare for ICD-10. An awareness of pain points can now help you predict where problems could occur for ICD-10. Also, plan multiple post-ICD-10 financial performance evaluations for your practice.
Switching to ICD-10 poses major challenges, and the conversion will happen whether you’re ready or not. Plan ahead and train your staff to avoid critical missteps that could be detrimental to your business operations and revenue. Without a doubt, ICD-10 will change the world of healthcare in the United States. However, using ICD-10 will gradually become normal as the years pass. Make your urgent care’s transition to ICD-10 as smooth as possible with proper preparedness.
1. Nichols, Joseph C. (2011, March). Applications and Technologies Collaborative ” ICD-10 ” Physician Impacts . http://www.christianacare.org/workfiles/medicaldentalstaff/icd10/ICD-10-Physician-Impacts-3-7-11.pdf
2. Centers for Medicare and Medicaid Services. General Equivalence Mapping. Based on 2011 GEMS mapping.
3. American Academy of Professional Coders Physician Services. ICD-10: The History, the Impact, and the Keys to Success . http://lgdata.s3-website-us-east-1.amazonaws.com/docs/718/475640/ICD-10-whiteapapaper-081511-1.pdf
4. American Academy of Professional Coders. ICD-10 FAQs. http://www.aapc.com/icd-10/faq.aspx
5. Mathews, Anna Wilde. (2011, September 13). “Walked Into a Lamppost? Hurt WhileCrocheting? Help is on the Way”. The Wall Street Journal. http://online.wsj.com/news/articles/SB10001424053111904103404576560742746021106