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One year to go ... are you ready for ICD-10?

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  By Betty Gomez, director of regulatory strategy, ZirMed, September 27, 2013

With the ICD-10 deadline just one year away, providers are in various levels of readiness, from completely unprepared to organized and on track. To determine where you fall in the continuum and what you should do to be ready, here are our top tips and tricks for ICD-10 readiness.

1.    Understand the landscape
First, it’s essential to identify who your key counterparts will be through ICD-10. This includes the EMR and practice management vendors, revenue cycle management vendors, clearinghouses and payers. Determine where each counterpart is in their ICD-10 process and what they are offering in terms of education, testing and support. At ZirMed, for example, we offer our clients an analytical mapping tool, which will help speed up the learning curve by identifying targeted coding and documentation risks, recognizing ICD-9 to ICD-10 relationships and flagging unspecified codes, which could lead to ICD-10 claim denials. Once you understand the resources that are available through your counterparts, you can begin formulating your action plan for ICD-10 readiness.

2.    Develop your training strategy
Begin training with general education of staff. Be sure to emphasize the importance of the upcoming ICD-10 transition and communicate proactively with staff about what to expect. Next, create a list of codes that will need to be changed. Remember that some of your counterparts might already have this available to you. If you have enough time and coders, dual coding is a good training technique because it allows your staff first-hand experience to practice inputting the new codes. It’s important to practice dual coding on a limited number of codes and not the whole list. We recommend practicing with your frequently used codes and codes that have the highest revenue impact. Keep in mind that formal in-depth training should take place between May and September, closer to the implementation date. The objective of this more formalized training is to improve provider documentation and more granular coding. It’s key to complete training on the software enhancements before you start testing the upgraded software.

3.    Test … test … and test again
Once you have your training plan in place, it’s time to start testing. Conduct internal testing with providers, coders and your revenue cycle team. Then you can work with software vendors, clearinghouses and payers to facilitate external testing. Reach out to your critical payers and understand what type of testing they are willing to offer. It’s critical to get on their testing schedule right away. Once you have tested both internally and externally, evaluate your ability to do both simultaneously. 

4.    Risk mitigation
Start by identifying your organization’s areas of greatest vulnerability. What procedures, departments, personnel and payers will be impacted by ICD-10 the most? Make sure that you are communicating to key stakeholders, billers and financial personnel equally. It’s important to strengthen the relationship between the financial and clinical side in order for an organization to successfully navigate through a successful ICD-10 transition. Also, make sure to focus on the codes with the most operational and financial impact (highest cost and volume).

5.    Impact analysis
Based on your risk analysis, look at the various impacts that ICD-10 will have on your organization. What will your potential dollar losses be due to denied or underpaid claims? Make sure to allocate time for training and weigh the opportunity cost for personnel and technology expenses. Prepare a contingency plan in case systems don’t work or payers aren't ready. It’s important to increase your vigilance on accounts receivable and denial management following ICD-10 to anticipate higher denial rates and reduced payments. While you’re planning for the possible risk, don’t forget that there is a huge benefit for your practice, as well. ICD-10 promises to dramatically improve physician documentation and coding, increase accuracy of patient records, streamline appropriate reimbursements and decrease claims denials in the long run. ICD-10 empowers practices to determine the severity of a patient’s illness and prove medical necessity consistently, which reduces the hassle of audits and ultimately improves patient care, as well as clinical, financial and administrative performance.

At the highest level, visualize what a successful post-ICD-10 organization looks like, think through the changes for your organization and start laying out the steps to get there. We’re working with thousands of providers who are going through the same process and, trust me, if you do that much, you’ll be ahead of the game.


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