1. Learn From HIPAA 5010 Transition. Last year, the HIPAA electronic claims
standard changed from version 4010 to 5010, and the transition served as a lesson for the
upcoming switch from ICD-9 to ICD-10. Practices most prepared for to adopt version
5010 had planned well in advance of the deadline. Practices should develop a checklist of
planning activities for ICD-10 and complete them on schedule.
Communication and coordination are also key. Thorough communication and
coordination is crucial within your office, as well as between business partners such
as vendors, clearinghouses and billing companies. Finally, testing should take place
throughout 2013 to acclimate all involved personnel ahead of the 2014 implementation
deadline. Be sure to test multiple types of transactions, and share your test results with
2. Budget for training. Starting Oct. 1, 2014, anyone filing a claim with an insurer or
government health program must use the new diagnostic coding system. While ICD-10
will bring greater documentation specificity, the implementation of ICD-10 will likely
not be easy.
Joe Zasa, co-founder of ASD Management, said surgery centers should be preparing for
the transition to ICD-10 now, even though it's not due for another year. A transition
to ICD-10 will require training for physicians, coders and business office personnel,
probable upgrades to surgery center software and discussions with payors about any
changes that will occur under the new system.
"You have to be budgeting for your people to attend seminars and classes," Mr. Zasa
said. He also recommends setting aside money in case of payment delays, while payors
adjust to the new system. "I think payors are going to struggle due to the voluminous
nature of the change for them," he said. "It may be a real challenge."
3. Be aware of RAC potential. CMS' Recovery Audit Contractors work to recover
inappropriate Medicare payments, and about 73 percent of automated denials were from
hospital outpatient services. Though outpatient and ASC services will be billed in CPT,
the diagnosis must be expressed in ICD-10 CM on or after the deadline. Without using
ICD-10 CM, future RAC audits will increase the risk of claim denial.
4. Ask the right questions. If you already have a certified electronic health record
system, make sure the ICD-10 upgrade is covered in your contract. Here are some
questions to ask your vendor about options and pricing.
• Will there be additional costs to accommodate ICD-10 codes?
• Will my contract need to be modified to include ICD-10 codes? What are the terms?
• Will my system be ICD-10 ready by 2013 so I can begin ICD-10 testing?
• What level of customer support and training is offered? Are those costs included in
5. Get physicians comfortable. Physicians are resisting the implementation for various
reasons, including the additional strain on resources, increased costs, the potential for
negative effects on reimbursements, fear of the unknown and the changing deadline.
However, the switch may not be as bad as the anticipation. Experts do not think the
change will cost as much as providers think. Productivity also suffered greatly in other
countries because they moved from older systems to EHRs, but the learning curve
will be smaller for ICD-10 code changes alone. Many extra codes won't be needed in
practices, and overall, it will not change the way physicians practice medicine. Work
with physicians now to help them know what to expect and be comfortable when the time
More Articles on ICD-10:
Physicians Remain Reluctant to Embrace ICD-10
7 Questions to Ask EHR Vendors About ICD-10
ICD-10 May Impede Healthcare Fraud Detection