As a medical provider or practice administrator are you prepared to transition to ICD-10? Many practices are ready for the new system, but some are way behind and will have medical claims rejected if they aren’t using the appropriate codes. In order to avoid billing problems with Medicare and Medicaid medical providers need to get up to speed on ICD-10.
The World Health Organization has created the 10th revision of the International Classification of Diseases, called ICD-10. It is a system of codes for medical records that includes diseases, symptoms, abnormal findings, and external causes of injury. ICD-10 replaces ICD-9, which has been in place since 1979, and providers are mandated to migrate to the new codes by October 1, 2015. Although the deadline has been pushed back twice since its original date in 2011, experts feel fairly certain that it will not be delayed this time because the United States is the only developed nation in the world still using the old codes.
The transition to ICD-10 is not easy; there are about 10 times as many codes in the new system as there were in ICD-9. So why the change? Do we really need a new, more complex set of codes? According to the Centers for Medicare and Medicaid Services (CMS), the answer is “Yes.” CMS says that there is a need for more accurate payment for services when reimbursing providers, and they claim the new system will enhance the evaluation of care and outcomes. Additionally ICD-10 is supposed to be more flexible and precise in identifying diagnoses and procedures.
In preparing for the transition to ICD-10, you are not without help. There are many private IT companies that can assist you for a fee, but you should be able to find enough free help to navigate through the process on your own. The best place to start is with the free resources on the CMS website. A recent press release announces that CMS and the American Medical Association (AMA) will work side-by-side to help educate providers through webinars, on-site training, and educational articles. The CMS website has a helpful Q&A list available for basic guidance. Take advantage of these resources, and take the time to dig in to the details of ICD-10 so that you have a deeper understanding as you lead your practice through the transition.
CMS suggests the following steps to prepare providers and staff prior to October 1st:
- Download the new codes from CMS – or you can request a book or DVD
- Consider contracting with a clearinghouse to get help with rejected claims
- Train your staff – the “Road to 10” plan is an excellent resource and a good place to begin
- Use the free CMS webinars that the entire staff can listen to
- Get help from medical societies and professional associations
- Identify the top 25 codes you use most often
- Update your paper and electronic forms
- Contact health plans and other vendors to make sure they are ready and run a test
- Verify and test your systems to ensure they are ICD-10 ready
- Conduct an Acknowledgement Test with the Medicare Administrative Contractors (MAC) prior to October 1st
Following these 7 steps should help prepare your practice for the transition to ICD-10. In addition to CMS, there are many other great organizations that can help you better understand the process. The Medical Group Management Association (MGMA), for example, has some excellent ICD-10 resources which are available to you on their website whether you’re a member of the association or not. However, members have the benefit of more resources including access to experts on federal guidelines and regulations.
No matter where you are in the process, make a timeline and get ready for ICD-10 – it’s coming soon!