In July 2014, the US Department of Health and Human Services (HHS) released a final rule on the compliance date for conversion to ICD-10 diagnostic and procedure codes. This incorporates the one year absolute minimum delay, which was imposed by Congress. Previously set for Oct. 1, 2014, the new compliance date will be on Oct. 1, 2015.
All healthcare providers are expected to already be taking measures in order to ensure a smooth transition especially since there is a vast difference between ICD-9 and ICD-10. Not only are the codes outdated, there is also a lack of space available for new codes to be added. Terminologies used are also no longer accurate due to changes in the practice as well as the discovery of new illnesses and diseases. Further, ICD-9 can no longer capture information important for research, tracking, improvement, and bio-surveillance.
2015 is thus, a year of transition. The question is: are you ready? To gauge whether your organization is on track with your preparations, ask yourself these questions.
1. Do you have a plan?
Healthcare providers now have more time to prepare and the best way to take advantage of this is to be proactive about it. Focus on the goal and develop a strategy on how to achieve it. Figure out what internal and external resources you will need. Who are the vendors who can help you with these and what tools do you need to help automate the process?
2. Have you conducted an enterprise-wide impact analysis?
Major code set revisions require an in-depth impact assessment. Review all your applications and forms. Determine which codes are used and identify the departments that use them. Identify documentation gaps so that you can start improving your documentation processes. Analyze your current claims to determine how they will be affected by ICD-10. Also, evaluate the present work flow in all departments in order to see how ICD-10 will impact them. Doing so will help you minimize negative outcomes and ensure a smoother transition.
3. Have you set a budget plan?
The transition can cost healthcare providers with a lot of money, which is why it’s imperative that you conduct a financial analysis. An article on Medical Economics states that “the American Medical Association estimates that small practices could spend between $ 56,639 and $ 226,2015 to implement the coding system”. Therefore, an enterprise-wide budget plan must be developed in order to prepare for additional costs involving the purchase of software and hardware, consulting, training and human resources. Also account for the possibility of encountering major problems during and after transition.
4. Have you started training?
Make training a priority. High-level training is necessary to prepare providers and coders for the eventual testing to be done, especially since there are a lot of changes in the ICD-10. For instance, from a diagnosis code set of around 13,000 in ICD-9, there will now be around 65,000 codes in ICD-10. Further, there will also be changes on coding for inpatient hospital procedures. Therefore, the earlier you start training, the better.
5. Have you developed a transition plan?
A detailed transition plan must be developed to include providers, payers and vendors. Communicate with them and make sure that they are also ICD-10 ready. Doing so will enable you to identify any gaps and address them as soon as possible.
Further, begin modeling and testing as soon as you can so that you can determine if your organization’s coding and documentation are working as they should. Before the October 2015 transition, testing weeks will be held by the CMS but you can start testing earlier if you can.
With less than a year to prepare, you have to start taking your preparations more seriously, if you haven’t already. Take this transition to ICD-10 not only as a regulatory compliance but also as an opportunity for you to redesign your business processes to ensure accuracy, efficiency and improved healthcare.
Medical coding is an essential aspect in the medical billing system. Accuracy and expertise on it are necessary factors to reduce the risks of your institution’s finances. If you arrive at a conclusion of outsourcing your medical coding process to us, we can assist you with everything included in it—from organizing patient’s data to accomplishing all things needed. Learn more!