On October 1, healthcare providers will need to switch from ICD-9 to ICD-10 coding. There are administrative measures they can take to prepare for the transition, said Jim Daley, director of IT for BlueCross BlueShield of South Carolina and workgroup co-chair for the Workgroup for Electronic Data Interchange. The first is to be mindful of the dates and staffing. Providers would be remiss to have key staff members going on a 2-week vacation beginning October 1. It will also be important to have vendor and insurance contacts and their information readily available. If something looks suspicious, providers will want to know whom to call and how to reach him or her quickly.
Additionally, providers need to “sort through all of the hype to understand what they [practices] need to do.”
Daley also advises eliminating as much claim backlog prior to October 1 as possible. Any claims not submitted take away from cash on hand, which will be helpful if there are problems after the change.
Healthcare providers should be prepared for other potential changes in technology. If practices get a new system, or revise current systems to support ICD-10, there may be other new features within the system as well. It would be a good idea to talk to a vendor in advance to get familiar with any other differences that will arise.
Providers do not have to learn all of the new 68,000 codes in ICD-10. The point is to know the codes that are used frequently in a particular office. An impact assessment can show the most common codes used under ICD-9 and whether or not they will change under ICD-10. Most of these changes are related to increased documentation.
For instance, a nephrourectomy is 1 code in ICD-9 and 12 codes in ICD-10, said Ed Hock, senior director at The Advisory Board Company. The change is related to new notes physicians will have to make to document such surgical aspects as the resection site, laterality, and approach used during the operation.
Coders will be responsible for assigning the correct codes under the new system, but it will be incumbent on physicians to understand how their documentation will need to change. The conversion won’t change the way providers practice, just the way they record it.
Many providers are worried about testing with vendors and insurers to guarantee they are prepared for the transition. Hock, however, said he worries less about a vendor’s preparedness than a provider’s.
“You have to test the human element,” he said. “They worry about how ready the vendor is for them, but they should worry how ready they are for the vendor.”
When the Centers for Medicare and Medicaid Services tested their systems for readiness, 81% of claims submitted were accepted. Of those rejected, only about 6% failed because of ICD coding issues.
There may be only a small number of denials, but Hock recommends providers have an “open” conversation about this with payers. This will allay some fears providers might have of working with payers on problems after the transition.
“Mistakes will be made no matter how prepared everyone is,” he said. “They are going to have to talk about how they will go through this transition together.”
Daly recommends testing with payers, but said providers may not need to test with all of them. Some are doing extensive testing and offering results publicly, like CMS. Odds are, if their systems work with hundreds of other users, they will work with yours.
“If you walk into a room of several hundred people and there is a payer who ties his shoe in front of one person and it is shown on a big screen, do they have to walk chair to chair in front of everyone to prove they can tie their shoe?” Daly asked.
He recommends trying ICD-10 codes with a few payers to determine if the results are different than they would be under ICD-9.
It is possible that facilities could take a revenue hit after switching from ICD-9 to ICD-10
Hock said a study conducted by his organization for a 250-bed hospital found that the facility would lose $1.5 million to $2 million during the year after the change because of things like insufficient documentation, payer denials, and coding problems. Hock said it will likely be “a series of small cuts” that will lead to losses.
As for vendor upgrades, they should have either already taken place or the vendor should be able to offer a very specific plan regarding their process. Providers should be asking what the plan and costs are, when they will receive an upgrade, and what their testing plan is for your specific office. Vendors should have precise answers to those questions.
“Vendors should be ready,” Daly said. “If there is going to be time for testing or course corrections, it needs to be done in the spring for testing over the summer.”