1. 10 steps to gateway of smooth ICD-10 transition
It is long since we started talking about ICD-10 transition. But, still most of us are unclear as what to do with the implementation. We are in fact awaiting the HIPAA 5010 change by January 1, 2012 that’s going to redefine healthcare compliance & enhance medical claims processing. This version will support ICD-10 changes which 4010 & 4010A cannot. should we wait till we go live with 5010 or at least till we hear final freeze updates from medicare or WHO?
No, says medical billing and coding experts in the field. Most of the medical billing companies have already started working on ICD-10 transition. This is because, getting acquainted with ICD-10 is essential to know the real challenges that can come across your way. Only then you will have time to fix the issues and get proficient with ICD-10.
Whatever be the challenges, we have to implement ICD-10 by Oct 1, 2013. So, it’s better to go for a smooth transition rather than learning it the hard way. How will you make this transition happen? Go for step-by-step implementation that will pave you way for smooth transition. Let me explain you how.
1. Form a committee: Setting up an ‘ICD 10 committee’ is essential to have control over planning and implementation. The committee should include people from the management, requirement analysts, medical billing and coding as well as IT experts.
2. Analyze requirements: A deep analysis should be done on requirements for ICD-10. Once the whole picture is clear, the committee should decide on implementation plan.
3. Plan: The ICD-10 implementation plan should include information about entire ICD-10 implementation initiatives, activities, people responsible to complete the tasks and importantly, the deadlines. Responsibilities should be delegated to every member of the committee who is skilled at working on the particular task and care should be taken to meet deadlines.
4. Allot budget: A rough budget should be allocated for implementing the plan that includes extra payouts for people, expenses related to system, software & documentation requirements.
5. Schedule regular meetings: ICD meetings should be held on a regular basis to discuss on progress, requirements and issues faced so that transition will be smooth without much of hassles.
6. Look for updates in CMS: Documenting the implementation plan is essential and the team should look out for any latest updates from CMS or WHO. Monitor the changes happening with ICD-10 and keep the team always informed
You can look out for updates in CMS website on:
i) GEM (General Equivalency Mapping) tools developed by CMS that can help in ICD-9 to ICD-10 transitions
ii) Policy changes related to ICD-10 transition.
iii) Updates on medical claims processing & ICD code changes
iv) Notices and remainders
v) Fact sheets and help materials to aid smooth transition
7. Go for planned training: CMS recommends that the training sessions can be classified in to Phase I & Phase II. The Phase II is recommended to commence 6 months prior to ICD implementation date. So, you need to plan the training accordingly.
A small team of coders can work on ICD-10 and get acquainted with the new codes while the coding team still works on ICD-9 till Sep, 31, 2013. Simulators and test cases involving ICD-10 can be implemented through pilot program and audited within the organization so that they will be able to foresee any issues that may arise after implementation of ICD-10 & take measures to control it. Knowledge transfer to other coders can happen once we get complete updates from CMS. Coders should then be cross-trained across multiple specialties for ICD-10
8. Speak to industry people: To know more about the changes required in software & system, speak to your vendors and connect with industry people. Since ICD-10 aids better reporting, tweaks need be done to the current medical claims processing system in order to track various parameters relating to performance like errors across different segments, deliverance, TAT violations etc.,- by specialty.
9. Complete backlogs: You will be completely held up with ICD-10 during the implementation period. Therefore you will not have time to concentrate on medical billing and coding backlogs. So, it’s crucial to complete the piled up backlogs in order to efficiently work with ICD-10.
10. Going live: Don’t assume that the implementation date will get postponed. The CMS is strict about the implementation date. In order to get your claims paid, you need to implement ICD-10 on Oct1, 2013.
2. Overview of ICD-10
Process revisions and implementations are not new to the US medical claims processing industry. But, after the ICD-9 transition in 1970s, ICD-10 is the major change that the medical billing and coding industry faces. We know that United States is not the first nation to implement ICD-10. Canada implemented ICD-10 in 2001, Germany in 2000, Australia in 1998, and the United kingdom in 1995 itself. As opposed to other nations that implemented ICD-10, the US has much enhanced ICD-10 coding setup due to the medical advancements that has happened during these years.
Let’s see the key factors about ICD-10.
ICD-10 Coding structure:
- ICD-10 has 3-7 digits when compared to ICD-9 that has 3-5 digits
- In ICD-10, Digit 1 is a letter, 2 a number and others (3-7) are either letters or numbers.
Who should implement ICD-10?
All entities in the United States that currently uses ICD-9 version like hospitals, physician’s offices, medical billing companies, clearing houses etc.
How many ICD-10 Codes for 2013 implementation?
This cannot be answered accurately till the last coding update is published by CMS. The current version contains around 150,000 codes including CM & CPT codes.
What will ICD-10 change?
The ICD-10 coding system introduces thousand of diagnosis & procedure codes for better specificity. As far as CPT codes are concerned, changes are made only to the in-patient hospital procedures where as outpatient & office procedures are not affected by the ICD-10 coding system. ICD-10 will make changes to the medical billing and coding operations.
A new dimension to medical billing and coding:
The use of ICD-9 codes was limited in terms of reporting & specificity. The ICD-10 coding system introduces a new dimension of ‘specificity’ to medical billing and coding by providing accurate codes for diagnosis and procedure.
Benefits of ICD-10 implementation:
ICD-10 implementation has multiple benefits.
- Improved quality in clinical documentation
- Improved quality in healthcare
- Control over healthcare fraudulent activities
- Great reporting features
- Interoperability with other countries
- Great accuracy with fewer codes
ICD-10 has to be implemented across the United States on October 1, 2013
3. Benefits of implementing ICD-10
The ICD-10 is not a mere update in the coding system. ICD-10 is a streamlined set of codes that enables greater ‘specificity’ in indicating the exact medical condition of a patient and procedure done. This specificity will provide multiple benefits to the medical insurance billing and coding as well as healthcare industry.
Improved quality in clinical documentation: The ICD-10 coding system is much dependant on clinical documentation. Since thousands of diagnosis & procedure codes have been added to ICD 10, the precision of the codes depend on the clinical documents. So, with the implementation of ICD-10, quality of clinical documentation will improve.
Improved quality in healthcare: With ICD-9, the major focus was to improve reimbursements. But, ICD-10 coding setup supports ‘performance based payment’ system rather than aiming at returns. This will change the way healthcare is and will improve the quality of care.
Preventing healthcare fraudulent activities: National Healthcare Anti-Fraud Association (NHCAA) cites that anywhere between $70 billion and $234 billion is lost annually through healthcare frauds. Healthcare frauds are becoming common in the medical billing industry also, focusing majorly on medical insurance billing and coding manipulations involving medical billing services providing companies, hospitals and other healthcare entities. ICD-9 is more generic and allows tweaks to be made in coding to get better reimbursements. But, in ICD-10, the codes are specific and prevent manipulations to a great extent. This will over a period of time, have control over medical billing fraudulent activities as well.
Reporting features: Since the ICD codes are used for health surveillance and researches also, specificity in ICD-10 will reveal the exact health condition of people in the US. For instance, for ‘Brain tumor’, the ICD-9 CM assigned was generic. In ICD-10 CM, there are specific codes to mention if the ‘right’ or ‘left hemisphere’ is affected and whether it is ‘occurrence or recurrence’. All this will provide better insight to the healthcare department & help in efficient ‘disease management’.
Sharing of health information with other countries is difficult to US with ICD-9, since all other countries except a very few, follows ICD-10 coding system. Now, with the implementation of ICD-10, US will be able to bridge the gap by sharing information across borders more efficiently and thereby empowering quality of care.
Great accuracy with fewer codes: ICD-10 will contain nearly 150,000 codes including CM & PCS. Though there are thousands of codes newly included, you can accurately describe a medical condition or encounter with fewer codes when compared to ICD-9 that needs more number of codes to indicate the same.
4. Dos & don’t of ICD 10
If you are a physician billing company providing physicians billing services to hospitals & medical practices, you have to take extra care to implement ICD-10. As a provider of physicians billing services, you will be responsible for complete ICD-10 transition and you cannot depend majorly on your clients.
- Don’t procrastinate or don’t do it in haste: Have an implementation plan and work accordingly. The implementation goes live on Oct 01, 2013. So, don’t do it fast and mess up or don’t procrastinate on ICD-10 implementation, waiting for others to start or the deadline to change. Start now – The more you delay, the more you are at risk of working at the last minute. Let things happen on its own pace, as planned, so that you have time to sort out any issues arising of the implementation, well in advance.
- Don’t leave everything to coders alone: The complexity of the ICD coding system demands lot of groundwork from the coding team. Since the coders have to manage with ICD implementation as well as current work, don’t make them solely responsible for the implementation. The ICD 10 transition should be a combined work involving the transition management team, IT team and the medical insurance billing team as well.
- Give proper training to the coding team: ICD-10 requires comprehensive training sessions for coders. Apart from educating the coders about ICD-10 codes, add real life – case based exercises and medical terminologies to the training module that will induce logical thinking in coders and help them act independently when they start coding for ICD-10. ICD-10 also requires basic insight on ‘Anatomy and Pathophysiology’ modules. So include these as short courses in the ICD-10 training sessions.
- Choose the right technology: Many healthcare IT companies have launched tools to aid with ICD-10 implementation. You need to be cautious in choosing the right system to suit your requirements. CMS provides latest updates on these tools in its website.
- Be in loop with latest ICD-10 updates: Though the implementation of ICD-10 is dated to OCT 01, 2013, many healthcare entities have started preparing for the implementation. Updates with ICD-10 are being made by medicare frequently and you need to be well informed about the latest changes happening in the industry to keep pace with the ICD implementation. Make it a practice to look for medical insurance billing & ICD-10 updates in CMS website
- Update your clients: Update your clients regularly regarding ICD-10 implementation initiatives taken by you. Explain them your plan and in fact any hurdles that you face so that they will know your commitment to ICD-10 implementation.
5. Coping with productivity drop during ICD-10 transition
Many healthcare entities as well as medical coding & billing companies are concerned about ICD-10 transition. What’s stopping medical coding & billing companies? Apart from the initial hurdles and cost factor, the main troubling parameter is productivity drop during ICD 10 transition. It is estimated that there will be a drop in productivity by 20-50% during ICD-10 implementation, varying for different medical claims billing entities.
It is common that there will be stagnancy in work during implementation of any new process. But ICD-10 has turned out to be a big challenge to the medical claims billing industry, affecting the daily operations. To balance this, it is essential to follow a streamlined productivity improvement plan that will efficiently solve the productivity issues.
Estimate the potential of your coding team:
Monitor the current productivity of your medical coding team for a month and calculate their daily productivity in numbers to know the actual potential. This report will be the baseline for your ‘productivity improvement plan’.
Divide your coding team in to 3 vital groups:
Once you start with ICD-10, you have to organize your coding team in-to 3 groups based on the skill set, experience and interest of the coders. By doing this, focus on productivity will not be lost and teams will be able to perform better.
1. Backlogs: Have a team handle any backlogs since completing this is essential to get a smooth start to ICD-10. You can use your coders with average experience on this.
2. Day-day work: Similarly you can assign newly joined coders who have little experience to handle the day-to-day work.
3. ICD 10 transition: Once this assignment is made the experienced coders with analytical skills can work on the ICD-10 transition.
Arrange for regular meetings:
Meetings are a must when implementing a plan. So, arrange for regular meetings and discuss with the 3 teams separately about their progress and check if they face any issues in their current scope of work. Help them out and encourage them to do well. Discuss on parameters like productivity, controlling errors & time management. Track productivity of the groups – only numbers can speak when productivity is concerned. Provide extra support to your ICD team to face the new challenges.
Provide periodical training sessions:
Based on the scope of work, provide quality training sessions to coders to handle their task more efficiently. Better the training, you will get better results.
Use technology to boost productivity:
Technology can transform processes and reduce complexity of a work. Analyze and find out tools that can help you in completing your task faster, thereby reducing the ‘turnaround time’ and increasing productivity. Errors and rework can affect productivity. So, go for system that can do better check on errors by providing alerts. Have a system in place to track your productivity.
Monitor & review the results: Finally, you have to measure the results of your productivity plan. Make quarterly reviews to know the outcome of the change. Once the ICD 10 initial setup is over, you can arrange for planned knowledge transfer sessions for other two groups and cross train them.
These guidelines can help you in managing the productivity drop in medical coding & billing operations during ICD-10 transition in a better way and deliver enhanced results.
6. Clinical documentation needs of ICD-10
Clinical documentation is an integral part of health Information Management. The clinical documentation needs doesn’t end with diagnosis and treatment of patients. It is also needed for efficient medical claims processing. Clinical documentation remains the source for the coders to assign the exact diagnosis and procedure codes. Let’s explore more about the dependency on clinical documentation with ICD-10.
- ICD-10 is an organized coding system that contains more than 150,000 specific ‘diagnosis and procedure codes’ for diseases. In ICD-10, due to its ‘specificity’, coding is much dependant on clinical documentation for medical billing reimbursements. So, the clinical documentation should capture all possible observations including even minute variations in procedure done for patients, which will be captured in coding through specific ICD-10 codes and the claims will get paid for the allotted amount for that procedure. Which means ‘better the clinical documentation; better will be coding and thus reimbursements’.
- It’s essential to evaluate the current clinical documentation procedure of ICD-9 and explore the clinical documentation needs for ICD-10. This GAP analysis will enable better focus to clinical documentation. Claims that are sent on/after Oct01, 2013 will strongly depend on specificity of clinical documentation.
- It is necessary to identify the introduction of new terminologies in clinical documentation and get the coders acquainted with the terminologies to get along with ICD-10 in a faster pace.
- Consulting a ‘clinical documentation specialist’ or recruiting them can help a lot when you start with ICD-10.
- When you work with clinical documentation, it is essential to decide on the point of communication – whom you will contact in case there are discrepancies in clinical documentation.
- Improper documentation will not only lead to denials or low reimbursements, but also increase documentation queries and reworks resulting in increase of the medical billing cycle.
- Consulting a ‘clinical documentation specialist’ or recruiting them can help a lot when you start with ICD-10.
Therefore, when implementing ICD-10, clinical documentation should also be given necessary attention so that it will not be a last minute surprise for you.