We’re seeing a lot of concern regarding ICD-10 implementation. After all the U.S. Department of Health and Human Services has issued a mandate that ICD-9-CM code sets currently used by medical coders and billers must be replaced. In short, current code sets for reporting diagnoses and procedures have to be replaced. Training your staff on implementation of the ICD-10 codes is vitally important to keep everyone on track - and your practice running smoothly.
But don’t panic, you don’t have to go it alone. MedTrainer can help with specific online training, and we’ll continue to post blogs and articles about the information you need to succeed with this change. Yes, there are literally thousands of new codes, but you don’t have to navigate the new International Classification of Diseases 10th Revision, alone.
The codes themselves are quite manageable - you’ll find the ones applicable for your team and those will the ones you use on a daily basis. Others will appear, but will not be as commonplace for you. Overall, you need to know what the government requires and how to acquire the knowledge you and your staff need to use this revised coding system accurately.
The U.S. is the last major developed nation to move to ICD-10 - we’ve been hanging on to ICD 9 the way Windows XP movers refuse to update their computers. Sure you know what you have now, but systems do get outdated.
ICD-10 comes from the World Health Organization, which collects diagnostic data for use around the world. The ICD system codes all healthcare diagnoses, tying them in the U.S. to the American Medical Association’s Common Procedure Terminology codes, so that the correct payment can be made for the practicing physician.
While it does seem daunting, the switch to the new coding system really had to be made. Today’s procedures have changed significantly, so that it is difficult to use codes for updated procedures, or procedures that did not even exist when ICD 9 was developed and put into use.
Currently, the ICD-9 system is 34 years old. Remember the old expression “don’t trust anyone over thirty?” Well in this case, the silly phrase may be apt indeed. It’s outdated, has no room for expansion, and the codes do not provide enough detail. The system is virtually obsolete. It’s over. Wave goodbye. The sooner the better - because although ICD-10 won’t officially go into effect until Oct. 1, 2014, training for the program and implementing it now will decrease greatly any learning curve for your practice.
So how to implement, exactly? As noted, MedTrainer can easily partner with your office regardless of size, to provide the training program you need to thoroughly reach all members of your staff and ensure compliance and knowledge.
But stepping out of the equation, here are the basic steps you should perform to get your practice on track.
First, get your team engaged. Coders, medical assistants, and all staff who document medical records should be involved in the planning for an education and training program that assesses current documentation, and looks at transition and implementation steps for ICD-10.
Second, conduct a so-called gap analysis. Take the top 25 to 40 diagnoses you see in your practice. Use current documentation, then code the same cases to ICD-10. What’s missing?
Third, train your staff. However you chose to do so, focus on your practice’s speciality and follow through to evaluate the ICD-10 and any clinical documentation improvement necessary. Capture specific data, and make proper changes to your health record system template.
Fourth, examine where you use ICD codes. You can make improvements in coding specifics as you identify.
Fifth, education is ongoing. Don’t rush the process. Lead your practice by providing detailed diagnoses for coding.
Sixth, be sure that you utilize the services of qualified trainers to get your staff in gear, such as, of course - the team here at MedTrainer. Don’t rely on untrained “experts” to assist your team.
Seventh, remember that good clinical documentation and coders trained in ICD-10, will, in the long run, result in stellar improvements in your practice’s overall efficacy.
Let’s look at how some of these changes will affect you. For example, using ICD-9, the code for a closed, mid-cervical fracture of the femur is 820.02.
ICD-10 requires an indication as to whether it’s the right or left femur, an additional or subsequent encounter with the patient, healing capabilities? ICD-10 uses four unique codes which require that you make a notation as to which femur, the encounter type, and any complication.
In short, ICD-10 requires more specific documentation for a more thorough documentation.
This thoroughness has been documented in other countries for years. We need to get with the program, even if the program takes us a little while to “get” it. The U.S. is 37th globally in healthcare, and using outdated coding systems certainly contributes to that low slot.
Another crucial reason for understanding and implementing ICD-10? ICD-11 is not far behind. In fact it’s scheduled to debut in 2015.
And there’s more. If transition to ICD-10 isn’t smooth, the American Medical Association has estimated that transition costs could be, hold on to your wallets - $87,000 to $2.7 million per practice. And that doesn’t include potential losses due to coding that is incorrect.
Okay, so deadlines are tight, the conversion process won’t be seamless, and it could disrupt both the practice itself and revenue. Yes, training coders is labor intensive. That’s where relying on an outside source for a smooth transition, with minimal staff downtime, is key.
ICD-10 is critical to the success of your practice and every healthcare practice that must implement. Which is simply everyone. You must use and follow a detailed project plan and the engagement of physicians in the plan must be a priority. Even though coding may be done by others on staff, it’s imperative that physicians understand how the coding affects their documentation. Pay attention to the details - they are now key.
Your practice should actively budget for ICD-10, including training of course, and any necessary IT upgrades, coding audits and also clinical documentation audits.
Be aware of, and responsive to any delays in reimbursement caused by the transition to this new system. Test use and billing system before the deadline, and use tools that can provide information about reimbursement trends to eliminate negative patterns.
But the ultimate tip is this: get started now. Recent HRAA reports have indicated that some 33% of you haven’t started implementation and are not sure how to begin doing so as recently as last fall. Where are you in the process?
Start with developing testing scenarios. Assess the results, look for reimbursement comparisons, adjust code maps, transform your IT system as necessary. IT focusing is imperative and helps to achieve your compliance, but at the heart of your practice, you need to analyze your approach to be sure payers don’t pay too much or too little.
You want to prevent any scenario in which waste or abuse costs you money - as it already does cost the overall US healthcare industry to the tune of some $234 billion a year. ICD-10 can be seen as another major issue, and a problem area that’s waiting to explode. Or it can be viewed as a way to eliminate problems, to cut back on waste, and provide clarity to your system. Analyze your own findings to identify your personal potential levels of waste or abuse, and optimize your system through ICD-10, not in spite of it. The goal here is not just to learn a new IT language and code numbers. It is to cut back on waste, abuse, and fraud and fix issues within individual practice systems. If health plans can catch errors and address them it will eventually result in the elimination of those billions of dollars lost, dollars that can be spent on medical research, patients, and practice efficiency.
Could it be that ICD-10 is actually a blessing in disguise? We are more than happy to don our Superman cape and help show you that this new system can be exactly that - through the proper understanding and use of this specified coding system.
Don’t be afraid - you will meet the target date for compliance, and you can get the help you need to eliminate problems and expedite the process. The biggest roadblock for successful implementation is time and money - aren’t those always the roadblocks for anything?
You can circumvent them by carefully diagramming your expectations and resources, get the knowledge you need for training, and have a solid plan of action to connect the dots during the transition process. Don’t delay. Accept and implement - and keep the positive future focus going. There is a light at the end of the transition tunnel.
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