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Preparing for ICD-10: Part 3

ICD-10 Readiness: Concerns for Medical Practitioners

Most medical practitioners will encounter similar challenges and benefits after integrating ICD-10. The primary concerns for the majority of providers will be related to:

  • Costs associated with implementation.
  • Delayed or lost payments during initial period.
  • Increased documentation requirements.

The fact that all practices must be ready to adopt the new coding system, having made all technological updates and improvements, while also providing staff and physician training by the cutoff date of October 1, 2015, may seem overwhelming, but it is possible to tackle this transition by breaking down the requirements and addressing them one at a time.

The increased need for documentation is perhaps the most significant issue providers will need to address during the transition, as it will require a substantial ongoing effort. The nature of ICD-10 diagnosis codes, in addition to the procedural coding system (PCS), will demand increased physician documentation. In other words, physicians will need to spend more time on patient documentation and patients will need to spend more time filling out their own paperwork. These factors will influence patient scheduling, likely resulting in physicians seeing fewer patients each day. Improved teamwork between the clinical staff and the coding staff will be critical, as a lack of communication will inevitably lead to coding or documentation errors that can prevent your practice from being reimbursed for care.

It will likely be necessary to assess, using a comprehensive gap analysis, whether or not your current coding and billing staff has the skill set required to use ICD-10. Only 24 percent of the current ICD-9 codes have a direct correlation with ICD-10 codes, so mastering the new codes will require a great deal of learning and professional development. Combined with the fact that the new coding system is much more specific, it’s likely that a hospital or clinic’s coding staff will need additional training in anatomy or biology to fully understand the terms being used. If these employees do not understand the new terminology, your practice runs the risk of coding and billing improperly and not being reimbursed for the care you’ve provided.

Because ICD-10 codes are much more specific than ICD-9 codes, the change will have an effect on payers who are seeking to modify the terms of their contracts, reimbursements or payment schedules. This, in turn, will impact business offices that will likely have to make changes to workflow and other administrative processes. Medical procedures requiring preauthorization could require additional diagnosis documentation that provides greater detail and specificity regarding the patient’s condition. For this reason, it is important to assess if the documentation your practice is currently keeping will sufficiently support the level of specificity required for ICD-10.

The changeover will have other impacts on payers, most of them beneficial as a result of greater code specificity. This will improve coding accuracy, which will make it easier to detect fraud. In addition, this level of detail will help payers gain a better understanding of the prevalence of chronic conditions and its providers’ practice patterns, and will also assist efforts to medically manage diseases and change medical policies. However, payers might experience problems during the initial implementation phase, such as a greater help line call volume. It is also likely that payers will be double-billed by some providers as a result of those providers running dual billing systems (ICD-9 and ICD-10) during the transition phase.

While healthcare providers and payers may both experience some temporary billing issues during the ICD-10 switchover, it’s expected that the new system’s increased accuracy will lead to more accurate payments, fewer rejected claims and greater billing efficiency. Manish Nachnani, a leading Health IT System Analyst, explains some of these benefits in an article published by Healthcare Reform Magazine: “ICD-10 will solve the problems caused due to lack of detailed information contained in the diagnosis and procedure code assignment…ICD’s improved precision in documentation of clinical care will greatly improve the likelihood of submitting accurate claims the first time around and receiving reimbursement for a range of procedures. As a result, there is a reduction in adverse impacts to the provider revenue cycle” (Nachnani, “ICD-10 Benefits for Healthcare Providers”).

ICD-10 READINESS

When your organization is ready to implement the ICD-10 coding system, there are several things to keep in mind. Training your clinical staff to use the new code set will require training time for coding staff, administrative staff and providers.

Of course, the training times and costs will vary depending on the types of training materials and resources available to your practice. Training can be simplified by choosing an EMR that offers access to various training options, including self-guided training videos and webinars. Throughout this process, it will be very important to maintain focus on the timelines for implementation.

To begin the process, consider appointing a leader in your office who has become familiar with the ICD-10 codes that you will be using most often to create a blueprint for the program’s implementation. This blueprint might involve a transition team and identify changes that need to be made, resources that are already available, resources that are needed and a metric for measuring success. It will also assess the training needs of anyone who will be involved in using the EMR and perform an audit of the current level of physician documentation.

The ICD-10 code set will be a major change in the healthcare industry. When it comes to ICD- 10, preparation is key. This mandatory change will require every medical practice to have an effective software system that will allow them to navigate this important change with ease. Your EMR software should be sophisticated enough to handle this change and should offer comprehensive training, information about integration and support to your medical practice during the transition. The right EMR will be an invaluable tool for your medical practice as you adopt mandatory ICD-10 codes and move forward in the ever-changing healthcare landscape.