It is long since we started talking about ICD-10 transition. But, still most of us are unclear as what to do with the implementation. We are in fact awaiting the HIPAA 5010 change by January 1, 2012 that’s going to redefine healthcare compliance & enhance medical claims processing. This version will support ICD-10 changes which 4010 & 4010A cannot. should we wait till we go live with 5010 or at least till we hear final freeze updates from medicare or WHO?
No, says medical billing and coding experts in the field. Most of the medical billing companies have already started working on ICD-10 transition. This is because, getting acquainted with ICD-10 is essential to know the real challenges that can come across your way. Only then you will have time to fix the issues and get proficient with ICD-10.
Whatever be the challenges, we have to implement ICD-10 by Oct 1, 2013. So, it’s better to go for a smooth transition rather than learning it the hard way. How will you make this transition happen? Go for step-by-step implementation that will pave you way for smooth transition. Let me explain you how.
1. Form a committee: Setting up an ‘ICD 10 committee’ is essential to have control over planning and implementation. The committee should include people from the management, requirement analysts, medical billing and coding as well as IT experts.
2. Analyze requirements: A deep analysis should be done on requirements for ICD-10. Once the whole picture is clear, the committee should decide on implementation plan.
3. Plan: The ICD-10 implementation plan should include information about entire ICD-10 implementation initiatives, activities, people responsible to complete the tasks and importantly, the deadlines. Responsibilities should be delegated to every member of the committee who is skilled at working on the particular task and care should be taken to meet deadlines.
4. Allot budget: A rough budget should be allocated for implementing the plan that includes extra payouts for people, expenses related to system, software & documentation requirements.
5. Schedule regular meetings: ICD meetings should be held on a regular basis to discuss on progress, requirements and issues faced so that transition will be smooth without much of hassles.
6. Look for updates in CMS: Documenting the implementation plan is essential and the team should look out for any latest updates from CMS or WHO. Monitor the changes happening with ICD-10 and keep the team always informed
You can look out for updates in CMS website on:
i) GEM (General Equivalency Mapping) tools developed by CMS that can help in ICD-9 to ICD-10 transitions
ii) Policy changes related to ICD-10 transition.
iii) Updates on medical claims processing & ICD code changes
iv) Notices and remainders
v) Fact sheets and help materials to aid smooth transition
7. Go for planned training: CMS recommends that the training sessions can be classified in to Phase I & Phase II. The Phase II is recommended to commence 6 months prior to ICD implementation date. So, you need to plan the training accordingly.
A small team of coders can work on ICD-10 and get acquainted with the new codes while the coding team still works on ICD-9 till Sep, 31, 2013. Simulators and test cases involving ICD-10 can be implemented through pilot program and audited within the organization so that they will be able to foresee any issues that may arise after implementation of ICD-10 & take measures to control it. Knowledge transfer to other coders can happen once we get complete updates from CMS. Coders should then be cross-trained across multiple specialties for ICD-10
8. Speak to industry people: To know more about the changes required in software & system, speak to your vendors and connect with industry people. Since ICD-10 aids better reporting, tweaks need be done to the current medical claims processing system in order to track various parameters relating to performance like errors across different segments, deliverance, TAT violations etc.,- by specialty.
9. Complete backlogs: You will be completely held up with ICD-10 during the implementation period. Therefore you will not have time to concentrate on medical billing and coding backlogs. So, it’s crucial to complete the piled up backlogs in order to efficiently work with ICD-10.
10. Going live: Don’t assume that the implementation date will get postponed. The CMS is strict about the implementation date. In order to get your claims paid, you need to implement ICD-10 on Oct1, 2013.
Medical practices that outsource their medical billing and coding operations to medical billing and coding should also confirm with them if the transition is happening as planned.