8 Steps for Small Surgery Centers to Make the ICD-10 Transition
1. Prepare for the code volume increase. ICD-10 is a massive code increase from ICD-9, so make sure the physicians and medical billing staff members are prepared for the change. The increase in codes will describe each visit and procedure more accurately, which means physicians need more detail in their operative reports than before.
"The different coding platforms include concepts such as laterality, combinations of multiple conditions together and a seven-digit number to indicate whether it was a new or returning patient," says Mr. Rodrigues. "Providers really need to understand the impact ICD-10 will have on their coding team."
2. Check for 5010 software compliance. The transition from the 4010 to 5010 software will support the move to ICD-10 in the future. The deadline for the first stage of 5010 compliance occurred earlier this year, but the deadline for the ICD-10 transition was extended to 2014. Despite the deadline extension, make sure your technology vendor has made the transition to 5010, or plans to in the near future.
"Really work with the technology vendor for your medical office and keep tabs on their progress toward 5010 and ICD-10 compliance," says Mr. Rodrigues. "There may not be definitive positions on ICD-10 since they have an extended deadline to 2014, but as we get closer to the transition date its important for providers to follow up with vendors and dig to a deeper level to make sure the steps and testing are done for ICD-10 compliances."
3. Appoint a leader to keep ICD-10 at the forefront of your practice. Even though the deadline for ICD-10 transition has been extended, it's important to always keep that change an active project at the surgery center. Appointing a staff member as the "leader" in ICD-10 can help you prepare for the future.
"The appointed leader should give updates to other staff members about ICD-10, your progress in the transition and preparation work still to come so you are ready for the deadline," says Mr. Rodrigues. "It seems like a long way off now, but I think providers will be surprised at how quickly it comes up. In smaller practice environments where everyone wears multiple hats, if nobody is assigned as a point person for the ICD-10 transition, it won't happen. It's important for providers to get out ahead of it."
4. Complete preparatory work. There are several steps of preparatory work required before completely transitioning to ICD-10. The appointed leader should be responsible for doing much of this work or delegating it to others.
"Put together a project plan which might include a lot of the pre-work to make sure the software is submitting claims in a 5010 compliant way," says Mr. Rodrigues. "They should also be doing an audit on the pre-ICD-10 payments to make sure there aren't any coding issues today and establish a good baseline for the transition."
5. Track payor accuracy. Tracking payor accuracy before the switch to ICD-10 will help you differentiate whether reimbursement issues are a function of ICD-10 or another longstanding issue. Make sure payors are paying current contracts appropriately and that your coding department is capturing all the right codes for full reimbursement.
"I think it's important to track the accuracy of payors today to make solid baseline for pre-ICD-10 and post-ICD-10 accuracy," says Mr. Rodrigues. "If they have trouble receiving reimbursement today, it's important to solve that in the ICD-9 world so when they do transfer to ICD-10 and find a disruption in cash flow they understand it's because of the transition. That way, they'll know how to solve the problem."
6. Update education regularly. There are several educational opportunities available for medical professionals about ICD-10. Practice or surgery center leaders can attend seminars or webinars on the overall transition while billing and coding professionals should attend courses to learn the new codes and coding methodology.
These educational opportunities are often held by medical associations, practice management groups or software companies, including Kareo (www.kareo.com). "The ASC's or medical practice's ICD-10 leader can be in charge of finding educational opportunities to prepare for the transition deadline," says Mr. Rodrigues.
7. Create a grid for common diagnoses. Begin to think about the transition to ICD-10 for common diagnoses at the practice or surgery center. Make a grid detailing the ICD-9 codes for these diagnoses and how they should appear in ICD-10 documentation.
"It certainly wouldn't hurt to begin by taking the most common diagnoses and creating a grid or spreadsheet mapping out the ICD-9 code and then the ICD-10 code so the coders can begin reprogramming their brain for the most common procedures," says Mr. Rodrigues. "Then the staff members can begin training themselves on that map."
8. Set milestones to reach along the way to your final goal. Make sure everyone at the surgery center is aware of the transition and set milestones to meet along the way to ICD-10 compliance. Keep your vendor in the loop about these milestones and make sure they support your efforts as well.
"Don't forget to involve your technology vendor in your ICD-10 preparations," says Mr. Rodrigues. "With the right vendor in place and the right educational plans in place, medical practices and ASCs will be better positioned to handle this big change".
More Articles on Reimbursement:
11 Statistics on Most Payor Coverage Denials
16 Tips for Optimizing an ASC's Revenue Cycle
8 Points no Whether In-House Billing or Outsourcing Services Makes More Sense for ASCs
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