by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
July 6th, 2015
Famous quote by Benjamin Franklin, “If you fail to plan, you are planning to fail!”
You are not the only one that put off planning as of April 15, 2015 about 50% of providers are not taking ICD-10 seriously as stated in the following article, by NueMD, “WEDI Survey says we’re not ready for ICD-10, as expected” .
“We assert that unless all industry segments make a dedicated and aggressive effort to move forward with their implementation efforts in the next few months, there will be significant disruption to industry claims processing on Oct 1, 2015. Regardless, we encourage all organizations to establish plans for addressing any unforeseen events that may occur during the transition.
Problems are sure to some your way if you neglect to look forward and plan ahead. With ICD-9 it was entirely possible to treat your patient, document the visit, code the visit, send in a clean claim and receive a direct deposit into your bank account all within 5 days.
While ICD-10 is not something to be afraid of it is important to be pre-paired for October 1st and after. The same processes need to happen with ICD-10 as we had with ICD-9, however the new processes will take longer. The over load of problems because you chose not to prepare may have a larger impact on your practice than anticipated.
It is important to understand what ICD-10 is and how it pertains to your practice.
Understand new coding concepts such as laterality and specificity and proper sequencing as well as the anatomy of ICD-10 just to name a few important changes.
Being a part of sales for ICD-10 Specialty books has been educational and amusing to hear the different responses and their preparation for ICD-10. Here are a few of the key reasons practices feel secure and fail to prepare.
#1 – ICD-10 is a myth
#2 - We will deal with it, if it happens. It has already been delayed twice!
#3 – We have an EHR. It has all the codes built in.
#4 - We just attended a 2 hour seminar, we are prepared.
#5 – It is just a new code set, we will just start using ICD-10 starting October 1st
#6 – We have a cross walk from ICD-9 to ICD-10, that is all we need, isn't it?
#7 – What is ICD-10? (Surprised?)
Most of the above responses will be dealing with the below consequences.
- First the cash flow stops.
- A shake out is without a doubt inevitable with your staff. You will clearly see the good from the bad, the determined and the faithful will stand out.
- Billing staff will be spending time entering denials, making phone calls to insurance companies and researching, instead of entering payments and making deposits. Don’t forget the phone calls from confused patients, they also get a copy of the EOB and can see the charges are not paid or are left as the patient’s responsibility. Optimistically, you have staff members that like to research, and take will not take the responsibility upon themselves and simply write off the charges as the payers state, “CO- Contractual Obligation-The patient is not responsible”. This is where you will sort the wheat from the tares.
- Coding staff will be notified of non-payment and in turn must notify the provider. Claims will need to be appealed, or if you chose to go ahead and send in a corrected claim, it will likely be denied as a duplicate, (that may be another 60-90 days without payment). It is now time to appeal, with documentation of course; I am betting some payers will require documentation with your appeals.
- The next step will require the provider, he/she is taken away from patients to amend the notes and perhaps learn the correct documentation that is required to get paid for the service rendered.
If you do not get help with ICD-10 you will start to feel the sting in your finances about the first of November 2015, you will know you are in trouble by December 2015.
How many patients are usually seen in a day? How many weeks has it been since ICD-10 started? Would now be a good time to purchase that book or use an on–line encoder?
There is help!
ICD-10 Specialty Training Books starting at $99 most specialties have over 500 pages. Including most commonly used codes for each speciality with Documentation Guides, GEMS, Alpha and Tabular indexing. InstaCode's ICD-10-CM speciality coding books have coding tips to help refine the particular codes or groups of codes, such as “Code First” and “Use Additional Code." as well as ICD-10 guidelines and ICD-10 training. These books help you get a jump start on your practice.
Find-A-Code – On-Line Encoder - A website that has been specifically designed to meet this need for enhanced medical coding and billing technology. An on-line database and simple search for Codes with instructions tips articles/newsletters, guidelines, teaching tools and webinars. Includes FREE Chat with great customer service to help you find what is needed on the site if you have questions.
InstaCode Institute – Coding resources Books, newsletters and articles.
The Ultimate ICD-10 Training Program - The Ultimate ICD-10 Training Program is designed as a single online resource for busy chiropractors (and any or all of their staff) to learn on their own time, at their own pace and as many times as necessary to make the ICD-10 transition as easy and painless as possible.
Start today! Learn ICD-10 and how it will pertain to your practice, consider specialist training.
Train Key Staff, they need complete understanding of the differences, mapping and terminology basics. Chose the type of training would benefit your staff, Webinars, Face to Face, web based, class room?
Ensure your EHR is prepared along with your Clearing house and payers.
Computer assisted coding or an on-line encoder will save you a lot of time such as Find-A-Code.com starting at $4.95/month. With ICD-10 Gems mapping, alpha index, search tools and billing guides to name only a few.
Start Dual coding your top 10 most commonly used codes. (check the documentation requirements and ensure templates and questions give you the information needed).
Schedule patients so you are not making them wait in the waiting room or Exam rooms while you prepare and train for the changes, now and once the changes are implemented this will take some stress of everyone.
There is some good news. Medicare announced you are required to use a valid ICD-10 code as of October 1, 2015; however, they will not do complex medical record reviews or automated reviews based solely on the specificity of the ICD-10 diagnosis code. This does not mean it may not be reviewed for other reasons. CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10.