Coding Updates: ICD-10 Implementation Plan


Your ICD-10 implementation plans are going to vary depending on the size of your business, how much medical coding you do, how easily your staff takes to change your computer software and a million other factors.

However, the implementation plan structure is really the same for anyone. You want to start with your clearinghouses and vendors. When you call them about 5010, ask them about ICD-10 as well. Are they going to be ready to transmit on time?

Then you want to take a look at your charge masters and super bills. A lot of practices use super bills that have a list of diagnosis on the back or down the side. And a doctor can just circle one as per the required medical coding rules. Those will have to be updated for ICD-10. And in many cases, you're going to need to leave blanks for the physician to fill in options like right and left.

You will most definitely not be able to get all the diagnosis you currently have on that form. So you may have to put well checked diagnosis or vaccine diagnosis with the charge instead of off on the side. Our expert suggested in a healthcare conference that it's a good idea to track for four to six months to see which diagnosis you used most often and which ones you can delete.

Now getting a super bill that both the physician and the biller are comfortable with takes a little practice and tweaking. So allow enough time for the physician to use the super bill for a week or so. And then revise it.

We suggest tracking diagnosis a year in advance and having the forms ready to go at least six months before implementation. Remember it's much easier to turn an ICD-10 into an ICD-9, than it is to turn an ICD-9 into an ICD-10.

The third thing you want to look out are computer upgrades. Is your software going to be able to automate the diagnosis field or does your staff have to get used to hitting the Shift key?

Depending on your billing system, your vendor may or may not load the ICD-10 codes into your system. A lot of billing programs do not come with preloaded codes. You have to buy a code on disk. If you're going to buy them, you need to make sure you’ve budgeted expenses for buying that codes on disk.

The fourth thing you want to look at your supplies. Is an ICD-10 book enough or are you going to need an ICD-9 versus ICD-10 crosswalk? There's enough difference in the codes. Crosswalks really aren't a whole lot of help.

And you look up an ICD-10 the same way you look up an ICD-9 so you're familiar with how to do that. It's probably a waste of your money but if you're using coding companions or quick coders with common ICD codes, you will need to repurchase those. So make sure you’ve budgeted for those and order those when you order your  books.

One resource we strongly recommend if you don't have one is a medical dictionary. The terminology in ICD-10 is very different from ICD-9. Standard cheat sheets will need to be manually updated as well so allow a little extra time for that also.

Also keep in mind that when you're looking at your Medicare local coverage determinations or national coverage determinations, they include a list of acceptable diagnosis and Medicare is in the process of updating all of those. So you will need to relook up each of your NCDs and LCDs to check for the appropriate diagnosis on certain claims as per Medicare guidelines.

Step five would be training physicians. Physicians are going to need to supply significantly more information in order to get paid. And they need to be trained on what information is necessary. How are you going to go about doing that?

At the very least, we suggest starting early and let the physician know when he or she is sending you a nonspecific diagnosis. Go ahead and enter the claim and fill it like you normally would. But also send it back to the doctor and let them know that in eight weeks, that claim will be denied.

That gives them very specific and personal advanced warning before the changes begin to affect their paycheck. Your staff is going to need significantly more training than physicians. And you need to decide how you're going to achieve that.

Will you send one person out to be trained and have them train everyone else in the your office? Will you have an ICD-10 expert? Or are you going to send different people to different seminars and have them collect all the data and come together? More than ICD 10 training, your staff needs practice.We recommend at least three months practice for every member of the billing team. To lessen that impact in your business, you might want to graduate this part of the process and have a quarter of your staff that start dual medical coding.  If you want your staff to have more than three months practice, you need to start this process even earlier.

The last thing you really need to plan for are the financial impacts of this change. Industry analysts expect conversion to ICD-10 will cause a two to three months delay in claim processing. Remember you have extra coding time, you have extra data entry time, you have computer conversions, clearinghouses and insurance carriers that are all going to impact this change.

Your clients will also have a delay in income which could affect their ability to pay you as well as temporary delay the amount that's owed. If you start now, you need to put away two days expenses every month to have three months reserve by the time of the change.

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