Get Ready for Industry Wide Impact of ICD-10

Get Ready for Industry Wide Impact of ICD-10

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  Get Ready forIndustry-Wide Impact of ICD-10 By Bess Ann Bredemeyer, BSN, RN, CHC, CPC, PCS Director of Compliance Consulting Preparing for Widespread care by indicating more precisely the detail in clinical documentation that will Organizational Change diagnosis, and will better match the identify and support the diagnosis or payment for care to the care delivered. procedure. While some hospitals, practices and In time, it will promote greater vendors are focused exclusively on the efficiencies in care documentation and The specificity and expanded data heavy lift of qualifying for stimulus claims processing. will enable improved analysis of care funds and achieving meaningful use, delivery for quality and regulatory foundational regulatory change is on In some cases, providers will receive reporting. Increased detail for analysis its way. The change to an expanded more appropriate reimbursement for also can be leveraged for process code set for diagnoses and procedures, complex procedures that couldn’t be improvement and pay for performance. ICD-10-CM and ICD-10-PCS, will bring differentiated with the previous ICD-9 sweeping changes to the processes code set. What used to be one code The Centers for Medicare & Medicaid and IT solutions used by providers and in ICD-9 may be multiple or even Services (CMS) reports that coding payers, clearinghouses and software many codes in ICD-10 that provide professionals are advising organizations vendors. The Oct.1, 2013 mandate greater clinical specificity and can to begin training six months prior to the will affect all aspects of a provider’s better indicate levels of complexity. For compliance date. The American Health operations since the provision of care, example, the codes differentiate body Information Management Association along with the appropriate diagnosis parts, surgical approaches and devices (AHIMA) suggests starting three to six and procedure codes, drive the delivery used. months prior to the date. and business of healthcare. There should be fewer requests for All Care Stakeholders Benefits from the Change to more procedure information to validate Will Be Affected an ICD-10 Code Set reimbursement because of the greater specificity of the code set. However, The ICD-10 code set will have far- Already in use by other developed knowledge and application of the reaching impact on inpatient and countries around the world, the code correct code becomes even more ambulatory provider processes and sets are expanding from an approximate critical. Protecting reimbursement will departments — admissions, eligibility total of 20,000 to more than 155,000 require extensive training not only of checking, medical necessity, contracting, — almost an eight-fold increase. The coders, but also of physicians and other care delivery, ancillary services, billing, expansion may benefit the delivery of code users, who must provide the claims, super bills, encounter forms
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  and quality reporting.Payor processes healthcare data. CMS is requiring an 4. Create a project plan detailing will be affected extensively, including update of the 4010/4010A transactions essential components for success: medical policy, contracts and claims to the new ANSI X.12 Version 5010, Key components would include adjudication. All stakeholders must which among other things will support communications, training and a prepare to transmit transactions using the ICD-10 codes. ANSI 5010 must be software roadmap. the new 5010 format. in use by Jan. 1, 2012. 5. Identify clinical documentation The health IT systems that support See the 10 Steps for Providers to Get required for coding: Reinforce the the care stakeholders and processes Ready for ICD-10 below for a high level requirements in your organization’s will be affected — wherever there is a checklist to assess your readiness. policies and procedures. diagnosis or procedure code entered, 6. Schedule and implement processed or transacted (visible or 10 Steps to Prepare for ICD-10 updated IT solutions: Ensure invisible), changes must be made. your implementation schedule These 10 steps will help you get ready provides time to perform any system Because of the magnitude of the for the transition to the ICD-10 code sets. You may want to forward this upgrades, test releases and install difference in the number of codes to those in your organization who are updates. Determine when and how in the sets, many times there will be working on this initiative. long you need dual coding systems. no “crosswalks” with a one-to-one match. Software mapping tools will 7. Train coders on new code sets: provide an equivalency of one-to- 1. Establish governance and Review coder experience – the one, one-to-many, many-to-one, etc. responsibility: Identify a project new code set will require increased The government is providing General manager. For larger groups and familiarity with medical procedures, Equivalency Mappings to help in the hospitals set up a multidisciplinary anatomy and pharmacology. development of these tools. team and governance steering committee. Communicate the 8. Train physicians on new financial ramifications of not being documentation requirements: The Timeline for Change ready to gain buy-in and funding — Start Yesterday Educate physicians on areas from the executive team. that require increased clinical What’s the timeline? The date for use of documentation. 2. Launch your ICD-10 compliance the new code set is any service date or initiative: Hold your kick-off discharge date on or after Oct.1, 2013. 9. Perform service line assessments meeting and communicate timelines and potential impact to cash And contrary to the hope and belief of and impacts of the change to all many healthcare organizations, CMS flow: Review coding that supports staff. Ensure coders, physicians and your key service lines and most doesn’t appear to be backing off from other billing staff understand the that date. Because some encounters commonly assigned and highly impact on reimbursement and days reimbursed DRGs. will still be in process for previous in accounts receivable for claims service dates, it is anticipated that both that are not properly coded or 10. Use enterprise intelligence provider and payer systems will need substantiated. analytical tools and reporting to support both the ICD-9 and ICD-10 to monitor compliance and code sets for a period of time. 3. Conduct a readiness assessment: financial performance: Check Assess the impact to policies and first-time submission claims success CMS is laying the foundation for the procedures, payor contracts, training rate, reimbursement turnaround change by requiring an update of needs, staff augmentation or time, days in AR, source of claim systems that support the electronic outsourcing and determine software edits, source of denials and staff distribution of information (EDI) of vendor readiness. compliance/productivity.
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  Start Now. Whilethe date to comply About the Author may seem far in the future, don’t underestimate the amount and Bess Ann Bredemeyer, BSN, RN, complexity of change that will be CHC, CPC, PCS required. While many organizations are Director of Compliance Consulting hoping for a reprieve from the Oct. 1, McKesson Practice Consulting Solutions 2013 compliance date, CMS is holding firm at this time, saying there will be no Responsible for McKesson’s consulting delay. services related to physician practice coding and compliance, Bredemeyer If you need assistance in getting has more than 27 years of experience in ready for ICD-10, McKesson Practice assisting physicians, office, and billing Consulting Solutions offers services staff with their coding and compliance such as readiness assessment, roadmap needs. Prior to joining McKesson, development and implementation. Bredemeyer was the compliance and For more information, please email privacy officer for a large academic [email protected] or call health center and was an active 1-800-789-6409. practicing critical care nurse. She guest lectures at physician forums and residency programs, and has authored several articles relating to physician coding and compliance. McKesson Provider Technologies 5995 Windward Parkway Alpharetta, GA 30005 www.mckesson.com/practiceconsulting 1.800.789.6409 Copyright © 2011 McKesson Corporation and/or one of its subsidiaries. All rights reserved. All product or company names may be trademarks, service marks or registered trademarks of their respective companies. REV-629 02/2011