Seven Tips to Ensure a Smooth ICD-10 Practice Transition
By Aleksander Romanychev
Death, taxes, and ICD-10: They’re all inevitable. But in the short term, many medical practices that are unprepared or moving at the last minute may end up with chaos, claim denials, and unhappy patients.
The changes for health providers regarding ICD-10 are significant and, for some, overwhelming. Perhaps that’s why 65% of providers are consulting a third party to help them successfully migrate to the new coding system, according a recent study by medical research firm KLAS.
However, even with outside consultants, this process is not an undertaking that medical practitioners can simply delegate. It must involve the entire office and many office processes, and likely needs the involvement of a qualified third party to facilitate the transition, update software systems, train, and test to ensure that the level of billing reimbursement is as high as or higher than before.
A qualified consultant is someone who can provide a detailed road map, support and program internal software systems, and demonstrate a track record of strong customer service while maintaining 99% reimbursement rates or higher. It’s too risky and costly to cut corners in this process.
Here are seven points related to people, processes, and professionalism to consider during the ICD-10 transition:
1. Establish a realistic budget and costs for ICD-10 implementation. Seek professional advice on all hard and soft costs, such as system changes (software and upgrades), resource materials, and training needs.
2. Identify potential changes to workflow and business processes. The conversion to ICD-10 will affect many physician practice business processes and systems functions. In particular it will be necessary to consider updates in the following business processes:
• Referrals, authorization/precertification
• Patient practice intake
• Patient clinic encounter (including entry, clinical, and exit)
• Patient hospital encounter and hospital admission scheduling
• Physician orders
• Financial operations
• Risk management
• Compliance management
• Clearinghouse/billing entity relationship management
• Payer relationship management
• Research participation
• Public health reporting
• IT (software) operations (readiness)
3. Know the code. Detailed, exhaustive documentation related to code changes is critical, and a strong working knowledge of those codes, particularly ones used frequently in a practice, will raise claim-approval levels. Consider that the number of diagnosis and procedural codes is expanding from 17,000 to 155,000. Moreover, the principles of coding have changed as well.
The good news is there will be many more procedures for which to receive reimbursement, provided practitioners are aware of structure and the specific codes. We advise choosing the top 30 diagnoses used in a particular practice and concentrate on knowing how to code them properly with the corresponding ICD-10 codes.
4. Use EMR ICD-10 compliant software. Practices will now need a robust EMR system if they don’t already have one. Don’t automatically assume that the provider will handle ICD-10 upgrades immediately to accommodate the new codes. Check with the developer.
5. Test. After all the changes in training people, implementing processes, and making professional enhancements for ICD-10, don’t expect to just flip a switch and have it all work smoothly. A testing period of several months will enable practices to complete several types of transaction tests using ICD-10 codes with payers and clearinghouses. Testing—the process of proving that a system or process meets requirements and produces consistent and correct results—is critical to successful implementation of ICD-10. A capable billing provider that develops and supports its software solutions, which minimizes additional programming costs, can implement the testing and quality control.
6. Maintain 99% reimbursement following ICD-10. The goal is to implement these changes with consistent or improved reimbursement levels. Consider switching to an experienced billing provider who is ahead of the curve on technology, provides a level of assurance that reimbursement levels won’t dip because of the changes, and has trained its staff on the ICD-10 coding structure.
7. Transition partnerships. Ensure that the practice addresses its internal needs but at the same time is in sync with its clearinghouses, billing services, and payers to facilitate a smooth transition. Systems must be able to talk to each other. Also, determine how ICD-10 implementation may affect provider contracts.
It doesn’t matter how much time, money, and other resources are put into the ICD-10 implementation if each party, practitioner, staff member, and outside consultant doesn’t do what is needed to accomplish a smooth transition. However, lining up the right resources now will minimize disruption, enable the training to proceed at an orderly pace, and provide enough time to do adequate testing.
— Aleksander Romanychev is CEO of WCH Service Bureau, a global provider of health care practice services headquartered in New York City.