Posted in ICD-10 & Coding

ICD-10 guidance for procrastinating physicians

Carl Natale
by Carl Natale
ICD-10 guidance for procrastinating physicians

In case you haven't heard, the U.S. healthcare system will be using ICD-10 codes on Oct. 1. To help those physician practices that are just starting to prepare, Centers for Medicare and Medicaid Services (CMS) has put together a quick guide.

Assess How ICD-10 Will Affect Your Practice

As part of assessing how ICD-10 affects your practice, you should find out if you need:

Access to ICD-10 codes – You can find codes from a variety of sources, including:

Clearinghouse services – Some providers who are not ready could benefit from contracting with a clearinghouse to submit claims.

  • Clearinghouses can help by:
    • Identifying problems that lead to claims being rejected
    • Providing guidance about how to fix rejected claims (e.g., more or different data need to be included)
  • Clearinghouses cannot help you code in ICD-10 codes unless they offer third-party billing/coding services.

Clinical documentation and coding training

  • Train staff on ICD-10 fundamentals using the wealth of free resources from CMS, which include the ICD-10 website, Road to 10, Email Updates, National Provider Calls, and webinars. Free resources are also available from:
    • Medical societies, health care professional associations
    • Hospitals, health systems, health plans, vendors
  • Training for clinical staff—e.g., physicians, nurse practitioners, physician assistants, registered nurses—should focus on documentation, new coding concepts captured in ICD-10.
  • Training for coding and administrative staff—e.g., coders, billers, practice managers—should focus on ICD-10 fundamentals.

New forms – It is crucial to update hard-copy and electronic forms (e.g., superbills, CMS 1500 forms).

Systems upgrades – Double check that you’ve identified all systems that use ICD codes and need upgrades (e.g., practice management systems, electronic health record (EHR) products).

  • Call your vendors to confirm the ICD-10 readiness of your practice’s systems
  • Confirm that the health plans, clearinghouses, and third-party billing services you work with are ICD-10 ready
  • Ask vendors, health plans, clearinghouses, and third-party billers about testing opportunities
  • Transition costs for small medical practices could be substantially lower than projected earlier:
    • Many EHR vendors are including ICD-10 in their systems or upgrades—at little or no cost to their customers
    • Software and systems costs for ICD-10 could be minimal for many providers

Be sure your systems are ready

You’ll want to verify that you can:

  • Generate and submit claims
  • Schedule outpatient procedures
  • Perform eligibility and benefits verifications
  • Prepare to submit quality data
  • Schedule office visits
  • Update patient histories and encounters
  • Code a patient encounter

Testing
The best way to ensure your systems are ready is to test. Focus on your highest-risk scenarios like claims processing and the diagnoses you see the most often as you test any system that stores, processes, sends, receives, or reports diagnosis code information.

You can test:

  • Inside your practice
  • With clearinghouses, billing services, and health plans

And you can test even if your system is not ready. If you don’t have an ICD-10-ready system installed yet, you can still conduct meaningful testing. One good way to start is to look at ICD-10 codes for the top 10 conditions you see:

  1. Consider the volume of conditions and those that account for most of your revenue.
  2. Look at recent medical records for patients with these conditions and try coding them in ICD-10 for practice. Do the records include the documentation needed to supply select the correct ICD-10 code(s)?
  3. Use any cases of insufficient documentation to create a checklist for clinicians to consult.

All Medicare fee-for-service (FFS) providers who submit electronic claims can conduct acknowledgement testing with their Medicare Administrative Contractor (MAC) at any time until September 30:

  • You do not need to register to participate
  • You may submit an unlimited number of claims
  • You can acknowledgement test claims directly or through a clearinghouse or billing agency

To submit claims for testing, you must use:

  • Current dates of service
  • The test indicator “T” in the Interchange Control Structure (ISA) 15 field

For more information about testing your systems, check out the ICD-10 Testing Infographic.

Alternate Claims Submission Methods

  • Explore alternate ways to submit claims to health plans if you think your systems will not be ready for ICD-10 by October 1. For Medicare providers, options include:
  • Ask other health plans you work with about the options they offer

 Contact your vendors

If you aren’t sure your systems are ready for ICD-10, contact your vendors and other business trading partners.

Ask about testing opportunities

Confirm vendors and products are ICD-10-ready

  • Call your vendors to confirm the ICD-10 readiness of your practice’s systems
    • Confirm that the health plans, clearinghouses, and third-party billing services you work with are ICD-10 ready
    • Ask vendors, health plans, clearinghouses, and third-party billers about testing opportunities
    • Many EHR vendors are including ICD-10 in their systems or upgrades—at little or no cost to their customers
  • You can use forms available in the Road to 10’s Template Library to guide discussions with vendors, health plans, clearinghouses, and billing services
  • Double check that you’ve identified all systems that use ICD codes—e.g., practice management systems, claims submission systems, electronic health record (EHR) products—when contacting vendors
  • Update contracts with vendors and health plans as needed

Good luck

I sincerely hopes this helps. Please let us know what does and doesn't. Hopefully by sharing information we can make this easier.

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