3 Warning Signs You Are Not Ready for ICD-10

ICD-10 RedThe ICD-10 transition is fraught with challenges for physician practices. As the code set increases dramatically, practices that are not fully prepared will likely experience an increase in denials, ballooning AR and reduced cash flow. Here are 3 warning signs your practice is not ready for ICD-10. 1. Impact Assessment? Umm, What’s That? An impact assessment is the single most important task in your ICD-10 transition. Understanding all the areas and people that will be impacted will help you understand the work at hand and how to budget time and resources appropriately. You will be more likely to cover all your bases if you start out in a very organized way and break it up step-by-step. According to CMS, your impact assessment should evaluate how ICD-10 will affect:

  • Business practices – ICD-10 will change certain aspects of your everyday business processes. Once you have implemented ICD-10, you will need to assess the impact of the new code sets on your processes for referrals, authorization/pre-certification, patient intake, physician orders, and patient encounters.
  • Documentation changes – ICD-10 codes are more specific and detailed than ICD-9 codes. This increased specificity will yield more clinical data, but involve more precise and complete clinical documentation with each encounter, requiring:
    • Training for staff to accommodate the substantial increase and specificity in code sets added with ICD-10
    • Increased anatomical and clinical detail with each patient encounter
    • Consideration of physician work flow and patient volume changes
    • Changes to forms and documents to improve specificity for input with ICD-10
    • Revisions to superbills and other forms that will change to reflect new patient coverage policies and payment limitations
    • Changes to prior authorizations to reflect new policies
    • Greater specificity in both ordering and reporting lab services to health plans
  • Reimbursement structures – ICD-10 will cause changes in reimbursement schedules. Coordinate with payers on contract negotiations and new policies based on the expanded code set.
  • Systems and vendor contracts – Check with your vendors to make sure they can accommodate your ICD-10 needs. Coordinate with vendors on their readiness and timelines for completing system updates:
    • Establish a tracking system and timelines for milestones
    • Review existing and new contractual obligations with vendors
    • Coordinate vendor capabilities and work with your organization’s needs and expectations
    • Evaluate searchability of code sets and ease of use of vendor products

ICD-10 will affect nearly all areas of your practice, but with a thorough impact assessment, you can keep your day-to-day activities running smoothly while you transition to ICD-10. 2. My Vendor Will Handle Testing…I Think Don’t assume that all your systems vendors will be ready. There are many smaller vendors that are known to be throwing in the towel on this. Their current database structures will not support the transition to the longer code set and/or the investment required to update all their applications is too steep. Some are sunsetting older versions of their software and requiring extensive upgrades and/or transitions to whole new systems. You should reach out to all your vendors with a questionnaire that forces them to document their answers to your questions:

  • Will they be ready to move to ICD-10?
  • How well did they manage the transition to 5010?
  • Will they guarantee?
  • Is it ready for testing by the practice?
  • Have they tested through all their trading partners (payors)?
  • Will there be a cost to upgrade? Will we need new software? New hardware?
  • Will you provide training? How much will that cost?
  • Are there new tools in place to support more complex coding?

3. My Doctors Don’t Need Training Mastering the complexity and granularity of ICD-10 will require a tremendous amount of preparation and practice. And yes, physicians will require extensive training too. Even if they do not do the final coding of the encounter, they will need to understand the new documentation requirements. Some considerations of the training plan:

  • Physicians and coders will require the most time
  • Local or distance options are available (boot camps, conferences, online training, webinars)
  • You will likely need to add resources during the training process – temporary help or overtime
  • Make sure training materials are available to your staff

Starting now will give physicians and practice teams the time needed to prepare at a steady and reasonable pace. For more ICD-10 content, visit our ICD-10 Resource page.

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