Y2K came and went, and it was quite a letdown for the "gloom and doomers." Amidst the hype, it seemed like Y2K would have a huge impact on many aspects of our daily lives, but the clock struck 12:01 on January 1, 2000 and Y2K went down in the history books as one of the biggest false alarms of recent times.
ICD-10 conversion is not a false alarm. It is going to have real impact on clinical productivity. Like it or not, ICD-10 is going to happen and it is going to dramatically affect every aspect of the cardiology practice.
While work on ICD-10 was completed in 1992, the United States has lagged behind the rest of the world in implementation of the new codes. In fact, the outdated ICD-9 codes have been around since the 1970s.
While one can argue either side of the coin as it relates to the resultant specificity, the U.S. healthcare system is embarking upon this change, and the impact will be dramatic. We are moving from about 15,000 (ICD-9) to about 70,000 (ICD-10) diagnosis codes. If you are like most healthcare professionals, you're probably saying to yourself, "IDC-10 is still two years out. I am already dealing with many other issues that have impact right now. Two years is an eternity in the healthcare business." The reality is that the ICD-10 rule is final and there are two critical deadlines you need to be worried about:
• January 1, 2012 is the deadline for the conversion to the 5010 electronic claims transaction standard.
• October 1, 2013 is the deadline for the conversion to ICD-10 diagnosis/procedure classification standard .
Here are the top 10 things you need to know and do to prepare for ICD-10 conversion.
1. The ICD-10 rule is final. Yes, ICD-10 is going to happen. It WILL go into effect in October of 2013, and the compliance date is not flexible. The time to begin preparing for ICD-10 compliance is now. Every tool, system, report, program and interface in an organization involving ICD-9 diagnosis or procedure codes must be adapted for ICD-10.
2. ICD-10 will affect everything. The implementation of ICD-10 will impact ALL areas of the revenue cycle, not just coding. It may impact insurance, registration, medical necessity for procedures, financial policy, billing AR, collections and IT.
3. EDI Version 5010 is a prerequisite. Currently, electronic claims transmittal does not allow for the ICD-10 code format. ICD-9 codes are 3-5 digit numeric codes. ICD-10 allows for up to 7 alpha-numeric characters to reflect much more specificity. As an example, a commonly used ICD-9 code is Coronary Artery Disease, Unspecified, or 414.00. ICD-10 does not allow for a simple “unspecified” diagnosis per se so the provider must choose from a plethora of codes ranging from a simpler I25.1 – Atherosclerotic heart disease of native coronary artery, to a diagnosis as specific as I25.790 – Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris.
The current format that claims are transmitted in (EDI version 4010) cannot handle 7 digits or the alpha component of the new codes. Providers must be compliant with EDI version 5010 by January 1, 2012. The new EDI version will be able to accommodate both ICD-9 and ICD-10 codes so it can be used during the transition. Testing for EDI version 5010 should have begun last year, many practices are behind schedule.
4. Vendors should be testing 5010 now. If you haven’t contacted your vendors already, you are already behind the curve. Because practice management and EMR vendors are not considered "covered entities" under HIPAA law, they are not required to ensure your practice is in compliance. Most vendors probably will, but your practice is ultimately responsible, not your vendors. As a matter of good business practice, you should require your vendors to document their testing in writing. Make sure you review this carefully.
5. Create an ICD-10 conversion team. You can't push the ICD-10 conversion to billing. You will need to organize an implementation team of key staff members from each area of your practice: IT, coding, billing and clinical areas need to be involved. Nurses, MAs and a physician liaison should be a part of the conversion team as well. Larger practices should include more staff as necessary. For the physicians involved in the process, more tech savvy members are preferred.
6. Do a readiness assessment – Now. Perform a risk readiness assessment and an impact analysis now, if you have not already done so. This could take months and will potentially uncover other inefficiencies in your practice. This is a good time to look at efficiency, work flow and core processes that need improvement or redesign. ICD-10 could actually be a blessing in disguise for many practices, because it will force practices to really look at aspects of operations with fresh eyes.
7. Establish a firm timeline. This needs to happen immediately, if you have not done it already. Having a published timeline and "go-live" date is a must. We recommended using a GANNT chart or a Mindmap so the entire team is clear on when critical milestones must be reached.
8. Estimate a budget and consider insourcing or outsourcing options. If your practice does not currently employ certified coders (AAPC, AHIMA), you will probably want to hire a consulting expert with this certification. In addition, you may want to encourage one or more of your internal coders to gain additional certification to prepare for the conversion. There are many operational and financial risks in play as you make the transition to ICD-10. Make sure you have all of the expertise you need.
9. Prepare for a productivity impact. ICD-10 is clearly going to impact productivity in a huge way. It could be crippling. Early awareness, communication and training will help limit the impact on productivity later. Training should begin in the third or fourth quarter of 2012. During this time, you will want to design job aids and checklists for learning the new codes. On the other hand, training too early could end up hurting you in the long run because the new codes may not be fresh in people's minds when the actual conversion is made.
10. October 2013 is just the beginning. Don't think that the work will be over on Oct. 1, 2013. Compliance, training and productivity will be ongoing issues your implementation team will need to manage well into the future. Clinical documentation will continue to be critical. It's not just having the right codes; it's about having the appropriate documentation that supports these codes.
Learn more about Paragon Health.
ICD-10 conversion is not a false alarm. It is going to have real impact on clinical productivity. Like it or not, ICD-10 is going to happen and it is going to dramatically affect every aspect of the cardiology practice.
While work on ICD-10 was completed in 1992, the United States has lagged behind the rest of the world in implementation of the new codes. In fact, the outdated ICD-9 codes have been around since the 1970s.
While one can argue either side of the coin as it relates to the resultant specificity, the U.S. healthcare system is embarking upon this change, and the impact will be dramatic. We are moving from about 15,000 (ICD-9) to about 70,000 (ICD-10) diagnosis codes. If you are like most healthcare professionals, you're probably saying to yourself, "IDC-10 is still two years out. I am already dealing with many other issues that have impact right now. Two years is an eternity in the healthcare business." The reality is that the ICD-10 rule is final and there are two critical deadlines you need to be worried about:
• January 1, 2012 is the deadline for the conversion to the 5010 electronic claims transaction standard.
• October 1, 2013 is the deadline for the conversion to ICD-10 diagnosis/procedure classification standard .
Here are the top 10 things you need to know and do to prepare for ICD-10 conversion.
1. The ICD-10 rule is final. Yes, ICD-10 is going to happen. It WILL go into effect in October of 2013, and the compliance date is not flexible. The time to begin preparing for ICD-10 compliance is now. Every tool, system, report, program and interface in an organization involving ICD-9 diagnosis or procedure codes must be adapted for ICD-10.
2. ICD-10 will affect everything. The implementation of ICD-10 will impact ALL areas of the revenue cycle, not just coding. It may impact insurance, registration, medical necessity for procedures, financial policy, billing AR, collections and IT.
3. EDI Version 5010 is a prerequisite. Currently, electronic claims transmittal does not allow for the ICD-10 code format. ICD-9 codes are 3-5 digit numeric codes. ICD-10 allows for up to 7 alpha-numeric characters to reflect much more specificity. As an example, a commonly used ICD-9 code is Coronary Artery Disease, Unspecified, or 414.00. ICD-10 does not allow for a simple “unspecified” diagnosis per se so the provider must choose from a plethora of codes ranging from a simpler I25.1 – Atherosclerotic heart disease of native coronary artery, to a diagnosis as specific as I25.790 – Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris.
The current format that claims are transmitted in (EDI version 4010) cannot handle 7 digits or the alpha component of the new codes. Providers must be compliant with EDI version 5010 by January 1, 2012. The new EDI version will be able to accommodate both ICD-9 and ICD-10 codes so it can be used during the transition. Testing for EDI version 5010 should have begun last year, many practices are behind schedule.
4. Vendors should be testing 5010 now. If you haven’t contacted your vendors already, you are already behind the curve. Because practice management and EMR vendors are not considered "covered entities" under HIPAA law, they are not required to ensure your practice is in compliance. Most vendors probably will, but your practice is ultimately responsible, not your vendors. As a matter of good business practice, you should require your vendors to document their testing in writing. Make sure you review this carefully.
5. Create an ICD-10 conversion team. You can't push the ICD-10 conversion to billing. You will need to organize an implementation team of key staff members from each area of your practice: IT, coding, billing and clinical areas need to be involved. Nurses, MAs and a physician liaison should be a part of the conversion team as well. Larger practices should include more staff as necessary. For the physicians involved in the process, more tech savvy members are preferred.
6. Do a readiness assessment – Now. Perform a risk readiness assessment and an impact analysis now, if you have not already done so. This could take months and will potentially uncover other inefficiencies in your practice. This is a good time to look at efficiency, work flow and core processes that need improvement or redesign. ICD-10 could actually be a blessing in disguise for many practices, because it will force practices to really look at aspects of operations with fresh eyes.
7. Establish a firm timeline. This needs to happen immediately, if you have not done it already. Having a published timeline and "go-live" date is a must. We recommended using a GANNT chart or a Mindmap so the entire team is clear on when critical milestones must be reached.
8. Estimate a budget and consider insourcing or outsourcing options. If your practice does not currently employ certified coders (AAPC, AHIMA), you will probably want to hire a consulting expert with this certification. In addition, you may want to encourage one or more of your internal coders to gain additional certification to prepare for the conversion. There are many operational and financial risks in play as you make the transition to ICD-10. Make sure you have all of the expertise you need.
9. Prepare for a productivity impact. ICD-10 is clearly going to impact productivity in a huge way. It could be crippling. Early awareness, communication and training will help limit the impact on productivity later. Training should begin in the third or fourth quarter of 2012. During this time, you will want to design job aids and checklists for learning the new codes. On the other hand, training too early could end up hurting you in the long run because the new codes may not be fresh in people's minds when the actual conversion is made.
10. October 2013 is just the beginning. Don't think that the work will be over on Oct. 1, 2013. Compliance, training and productivity will be ongoing issues your implementation team will need to manage well into the future. Clinical documentation will continue to be critical. It's not just having the right codes; it's about having the appropriate documentation that supports these codes.
Learn more about Paragon Health.