Transitioning to ICD-10

With one year to go until the mandatory transition date of October 1st, 2014 to use ICD-10, providers and their billers need to start some important activities to successfully transition to the ICD-10 code set. The CMS (Centers for Medicare & Medicaid Services) advises that practices will experience some drop in receipts due to the ICD-10 transition and recommends that practices budget some cash reserves to mitigate this risk. Physician Billing Partners (PBP) is trained on ICD-10 & ready for the transition and recommends practices start the following ICD-10 planning activities to ensure a smooth transition: Training, Testing, & Transition to ICD-10.

Everyone in the practice needs to understand how ICD-10 will impact their work. PBP recommends up to 3 levels of training: Basic awareness training for all staff on ICD-10; General Code-set training on using ICD-10 for providers, and Specialty specific code-set training if needed. Total time to take the General Code Set training and Detailed training ranges from between 3 hours to 16 hours and can be taken online, book study, or via classroom format. PBP and the CMS (Centers for Medicare & Medicaid Services) recommend AAPC as a resource for ICD-10 training.
PBP and the CMS recommends AAPC as a training resource on ICD-10. AAPC has online courses and literature about ICD-10 as well as ICD-9/10 conversion tools (free until December 31st, 2013) Average cost per person for AAPC ICD-10 training is $395.

There are a number of systems that need to be tested to ensure claims can be submitted cleanly and prevent excessive drops in receipts. These systems include Electronic Health Records, Labs, Hospital interfaces, etc. Identify each system that uses ICD-9 codes, identify each partner that you transmit electronic ICD-9 codes to or from, and identify all documentation (e.g. Super bills) and workflows that use ICD-9 codes. Test each system with the assistance from your vendors to ensure the system processes the ICD-10 codes correctly. PBP Practice Management software and electronic claims submission with Electronic Clearing Houses (ECH) and provide feedback on your coding. Many ECH vendors are ready to test ICD-10 claims and provide valuable feedback based on their edits and error checking functions.

Your Electronic Health Record vendor should be your resource for updating system templates to accommodate ICD-10 codes. PBB can be available as needed to help you create various billing tests and to modify Super bills. PBP can submit test claims with Electronic Clearing Houses and provide feedback on coding adjustments.

NOTE: Most EHR vendors are well underway in making system changes for ICD-10. These changes will be implemented by a system upgrade - it is important to confirm with the vendors, when these upgrades will be available. Also, ensure your software maintenance contracts are current to avoid delays in upgrading your systems.

The CMS advises providers to budget for a fall in receipts after October 1st, 2014 transition to ICD-10 due to unforeseen ICD-10 conversion issues by any number of sources. To mitigate this risk, PBP recommends all dates of service prior to October 1st, 2014 be submitted by September 30, 2014 to avoid these claims being held-up and avoid the ICD-10 transitional issues many vendors will experience.