In the last post on ICD-10 project planning for the solo
practice, we looked at what the first few months might look like. Today we’ll discuss the changes we need to
anticipate in order manage those situations.
Learn ICD-10
Depending on your practice specialty and the number of
diagnosis involved, this may be relatively easy, or more involved depending on
the volume of codes you use.
So who needs ICD-10 training? Well, anyone who is documenting patient
information or is working with charges and claims. This means pretty much everyone in the
practice needs training. But different
roles will need different training. To
account for this, the practice should survey each job function to determine
what information is being dealt with related to ICD-9/ICD-10, then train to
that situation. ICD-10 requires greater
knowledge of medical terminology, anatomy, pathophysiology and pharmacology. Do your medical assistants have the necessary
knowledge to properly use ICD-10? How do
you plan to assess their preparedness?
How to you plan to train them, and pay for the training?
Cross reference ICD-9 to ICD-10 codes
Every ICD-9 code currently used by the practice will need to
be cross referenced to ICD-10. A good
place to start is to acquire a GEM (general equivalency mapping) document. Of importance here is the word “equivalency”. It is important to remember there is not a
1-to-1 relationship between ICD-9 and ICD-10 codes. One ICD-9 code may have three or more ICD-10
equivalents, and some ICD-10 codes don’t have an ICD-9 equivalent. The code you use will depend on the specifics
of a given situation and/or the policy of a specific payer.
You may also want to do a reimbursement mapping. CMS provides documents which present a single
recommended mapping of an ICD-10 diagnosis or procedure code to a single
ICD-9-CM alternative. This includes all
ICD-10-CM/PCS codes, but not all ICD-9 codes.
For GEMs and other conversion tools, CMS provides them on
their website for free. Many private
vendors also offer them for a fee.
Review forms
Any form dealing with patient information should be reviewed
and updated if needed. Billing sheets,
patient history forms, referral letters, lab orders, whatever. Do you have order forms for durable medical
equipment? Don’t forget to update those
if needed.
Update software
It should go without saying that EMR and practice management
software will need to be updated. Do you
have assurances from the vendor on that update?
If not, when will they provide it to you in writing? Survey the practice for other software which
may need updating. If you have an outside
billing vendor, survey them to make sure they will be up to date in time.
Review reference materials and how-to guides
It’s common for practices to have internally created
reference materials and how-to guides for employee use and training
purposes. Review those for possible
changes.
In 2013, don’t throw away your ICD-9 code books. Until all claims with ICD-9 are processed,
you may need them. And staff may
continue to need them for years to come because ICD-9 codes will continue to be
in the billing and medical record system.
Don’t assume a biller hired three years from now will know that 707.03
is decubitus lower back ulcer. They may
only know it as L89.44.
Review contracts and vendors
Review payer contracts for requirements regarding ICD-10. Any
mention of ICD-10 in that malpractice insurance policy? Has your outside billing vendor given you a written
timeline for their ICD-10 conversion?
Have you thought about ICD-10 diagnosis requirements for lab
tests? Will your lab vendor(s) provide
you with that data?
What about covered diagnosis for patients? You’ll need to be sure you know how payers handle
the transition so you can update patient charts with the appropriate ICD-10
code.
Review when payers are switching to ICD-10
Non-covered entities, such as worker compensation insurers,
are not required to make the switch from ICD-9.
It is anticipated most will convert to ICD-10 in order to make things
easier in the long run. But you should
determine if and when those you participate with will make the transition.
Process changes
Will ICD-10 change any of your internal processes? Don’t assume it won’t. Again, survey the practice to determine for
sure.
Budgeting for the change
The transition from ICD-9 to ICD-10 presents many
opportunities to take money out of your pocket.
And for most practices there will be some economic impact. Cost containment can be aided by actively managing
the transition and reducing variables which are out of your control. For example, what if some of your payers
struggle with the transition and payment processing is slowed down? Well, you can anticipate that by building up
a reserve fund to avoid cash flow issues.
Also, consider the effect on your employee
productivity. It is widely anticipated
that billers will lose efficiency for a few weeks or months as they learn to
code and process claims with ICD-10. If
your biller is 10-30% less efficient, what is the impact on your practice? Will you need to budget for overtime?
Will you be as efficient completing your encounter notes
with the increased documentation requirements?
Will the biller or medical assistant need to come back to you more often
and request more detail in order to support the diagnosis code?
How are you training your staff? Self-study, online class, AAPC ICD-10 Bootcamp? Are you going to run the office through some
scenarios so everyone can practice in a coordinated way? Will you do this on a Saturday;
close the office on a Friday? Have you
budgeted for this? What about vacations
during those times?
Next Steps
Hopefully I have given you some things to ponder. This isn’t a complete list, but should spark
your thought process. Next time we’ll give
further shape to these things by discussing how to manage the process and put
together a timeline.
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