What Does the ICD-10 Delay Mean for ASCs? 5 Steps to Get on Track
According to the April 9 proposed rule from the Department of Health and Human Services, ICD-10 diagnosis codes will be required for billing physician services starting Oct. 1, 2014 — one year after the previous implementation date of Oct. 1, 2013. Experts say the delay will give practices, surgery centers and hospitals the chance to catch up on implementation if they haven't already started. At the same time, facilities should not view the extended deadline as a chance to slack off for another year; starting the implementation process now is essential to preventing billing problems and loss of profitability come 2014.
Here Rhonda Buckholtz, ICD-10 director for AAPC, discusses five steps for surgery centers to get on track towards the implementation deadline.
1. Perform an impact assessment. Ms. Buckholtz says surgery centers should start the ICD-10 transition by performing an impact assessment. When she used to do practice management assessments, she recommended staff start with the first phone call and follow the patient through the practice to determine "areas of impact." She says an ICD-10 impact assessment works in the same way, only with a diagnosis code. "Follow the code around your center and record which departments it hits," she says.
She also recommends conducting a survey of different departments to see which forms, systems, policies and procedures use a diagnosis code. She estimates this process should take anywhere from three to six months, depending on the size of your facility.
2. Reach out to vendors. Once you understand how diagnosis codes work in your facility, you should start reaching out to your IT vendors to determine their plan for ICD-10. Your surgery center may need enhancements to systems you already have, or it may be more cost-effective to invest in a new system if you're primed for an upgrade anyway.
Ms. Buckholtz says many vendor contracts include language that makes upgrades through governmental changes or mandates free of charge — but that may not be all your center needs. "If you need additional training from your vendor or additional hardware, that won't be covered," she says. "But sometimes a simple upgrade will be free of charge."
3. Contact your health plans. Just as you need to contact your vendors to ask about their plans for ICD-10, you should also contact health plans to ask about testing periods and changes to your contract. "Coming off 5010, we realize how important testing periods are," Ms. Buckholtz says. "The lesson learned was that we did some testing, but not robust end-to-end testing, so a lot of processes have just started to get back on their feet because they suffered financial delays."
She says payors' plans will vary from company to company. Some larger companies are deep into revamping their systems, training their employees and mapping crosswalks from ICD-9 to ICD-10, whereas smaller payors may be slow to get started. Ms. Buckholtz recommends looking at your insurance contracts before you reach out to determine whether there's any language about medical necessity or diagnosis codes tied directly to payments. "You want to ask them what they're doing to be ready, how they might be able to help you get ready, and how your policy and contract with them is going to change," she says.
4. Perform a physician documentation readiness assessment. Training physicians on ICD-10 documentation should start sooner rather than later, Ms. Buckholtz says. "Take a look at existing physician documentation and start working with them on diagnosis codes and conditions to get them ready," she says. She says AAPC offers a course that goes over clinical requirements in ICD-10 and is tailored specifically to physicians. "It takes a documentation focus and looks at clinical conditions as they relate to diagnosis codes, not just from a coding standpoint," she says.
As you near the implementation date, quiz your physicians on ICD-10 documentation and give them refresher courses if necessary.
5. Start codeset training a year in advance. Ms. Buckholtz recommends surgery centers start codeset training for coders a year in advance. She says coders should start with general ICD-10 information and start focusing on the center's specific specialties once the date draws closer. "We estimate at least 16-20 hours spent on codeset training for coders," she says. "It takes me 16 hours just to teach the guidelines in ICD-10."
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