The following is a guest post by Barry Haitoff, CEO of Medical Management Corporation of America.
One of the biggest challenges to revenue a practice will face in 2014 is the move to ICD-10 on October 1, 2014. One of the biggest challenges with ICD-10 is that it impacts the entire healthcare ecosystem. This means that revenue flow could be impacted if any one part of the healthcare billing continuum isn’t ready.
The first key step every organization can take to prepare for the switch to ICD-10 is to do an audit of which systems, people, and processes will be impacted by the change. Second, you should evaluate the ICD-10 readiness of each system, people and process. Finally, you should make a plan for how you’ll ensure that each piece of the puzzle is ready for ICD-10.
Here’s a quick look at some of the places you’ll want to look when doing an audit of your ICD-10 readiness:
EHR Software
This is an obvious one. We all know that the EHR vendor needs to be ready for ICD-10. However, as John posted previously, Is Your EHR Ready for ICD-10, Not Just Say They’re Ready? it’s really easy for an EHR vendor to say they’ll be ready for ICD-10. At the core of being ready for ICD-10 is just being able to use a new code. Every EHR vendor will be able to enter the new code. Instead of asking if they are ready for ICD-10, you should ask your EHR vendor what interface they’ve created for you to be able to find the ICD-10 codes. You’ll want to get in and test this new interface for finding codes well before the ICD-10 deadline so they can make any changes to the software.
Providers
Every doctor I know understands they they’re going to have to be ready for ICD-10. They’ve heard about the expanded set of codes and how finding the right code is likely going to take extra time. What many doctors haven’t realized yet is that with increased coding specificity, the doctor’s documentation is going to have to change as well. Coding 101 is that the coding has to match the documentation. This will require every doctor to change the way they document their visit even if it’s only a small change.
Billing Software
This is another obvious one and many of the lessons mentioned above about EHR software apply to billing software. However, you’ll definitely want to make sure that your billing software is ready for ICD-10. Can you imagine the impact to your organization if they’re not ready? You might not think this is possible, but I’ve heard some billing software already announce that they’re not planning to revise their software for ICD-10.
Billers and Coders
This is the group that seems most prepared for ICD-10. Most people realize that the coders or billers in their organization need to be ready for ICD-10. Unfortunately for many organizations, that’s where they think all the ICD-10 preparation needs to happen. As this list shows, they are so wrong. However, if you haven’t invested in getting your billers and coders ready for ICD-10, then you better start doing so now. In some cases you may have an older coder that chooses to retire instead of learning ICD-10. Make sure you learn if this is the case now instead of October 1st.
Billing Company
It’s really hard to imagine a billing company not being ready for ICD-10. It’s a basic fundamental of them being a business. If they can’t do ICD-10 they’ll be out of business. However, it makes sense for you to check with them to see what they’ve done to prepare for ICD-10. You’re their customer and it never hurts to hold them accountable. If they don’t thank you up front, they’ll thank you on October 1st when they’re ready for the change.
Labs and Radiology
You’d think that these wouldn’t be that big of an issue since we’re just talking about a new code that gets sent to the lab or radiology. However, if they’re not expecting ICD-10 codes, your patients could run into issues. Plus, many of you have interfaces which send this information automatically. You’ll want to make sure that these interfaces can handle the new codes as well.
Payors
This is probably the most important one and also one of the most challenging. It is the most important, because if they’re not ready for ICD-10 that could mean that you stop getting paid. In many organizations, a hit to their cash flow could have serious ramifications. My guess is that some of you don’t think that this could ever really happen. I assure you that it could happen. Certainly they’ll eventually fix whatever issues they have and they’ll get rolling with ICD-10. Although, will it take them a week, a month, a couple months, to fix whatever issues they may be experiencing? Can you handle not getting paid for a week, month, or multiple months? The challenge is that there’s no simple way for you to know if the payors are indeed ready for ICD-10. The best advice I can offer is a famous statement, “The squeaky wheel gets greased.” Don’t be afraid to make some noise to make sure they’re ready.
Hospitals and HIE
Many vendors are starting to build interfaces with their hospital or an outside HIE (Health Information Exchange). If you have one of these interfaces, you’ll want to make sure that it can support the new ICD-10 codes. Don’t forget to check and test both sides of the interface for their ICD-10 readiness.
Other ICD-10 Readiness Advice
When assessing the readiness of the various entities listed above (and you will likely have others), it’s important that you ask the right questions to make sure you get the right answers. Much like when you’re evaluating between EHR vendors, you want to avoid asking Yes/No questions. For example, if you ask your EHR vendor, “Are you ready for ICD-10?” then you will quickly get a response of Yes. If instead you ask, “What have you done to get ready for ICD-10?” you will get a much more informative answer that helps you understand their true ICD-10 readiness.
Also, when doing your assessment of their readiness, don’t forget to also verify that they can handle ICD-9 for those situations where an organization still hasn’t moved to ICD-10. Yes, it’s crazy that some government organizations aren’t moving to ICD-10. However, it’s the stark reality, so make sure that when needed to you can still support ICD-9 as well.
In all of this, there’s a challenging balance between doing your training too early or too late. If you train your doctors on ICD-10 too early, then they’re likely to forget it by the time October 1st rolls around. However, if you wait until the ICD-10 deadline approaches, the resources for ICD-10 won’t be available. Can you imagine what it will be like to try and hire an ICD-10 coder or ICD-10 trainer in September?
Medical Management Corporation of America, a leading provider of medical billing services, is a proud sponsor of EMR and HIPAA.
