ICD-10 is the LAW, and it’s not going away. In August 2012, HHS announced a final rule moving the ICD-10 compliance date to October 1, 2014. This means that health plans, health care providers, and health care clearinghouses that transact standard health care transactions must use ICD- 10-CM diagnosis codes for services occurring on or after October 1, 2014.
The suggested timeline for a successful ICD-10 transition from start to finish is 18 months, meaning the time to begin preparing is NOW. What’s required is a sane, measured, and phased approach involving the following five phases: education & awareness, impact assessment, transition plan development, plan implementation, and implementation review.
Phase 1: Engaging and educating Physicians and Staff
Education begins with informing the physicians and staff of the regulatory requirements and deadlines for ICD-10, including the differences between ICD-9 & ICD-10. Physicians and staff should know how to use the GEMS mapping system, and what documentation changes need to occur to comply with increased code specificity. Additionally, the benefits and opportunities of ICD-10 CM should be understood.
Phase 2: Assessing Current Readiness and Impact
ICD-10 will touch all aspects of a practice, so understanding current readiness is paramount to a successful implementation. Health care providers should begin to ask themselves how this new coding system will affect documentation and reporting, as well as the influence it will have on office processes. Physician practices will need to examine the significance of this transition on referrals, payers, and business partners. Budget and productivity will be affected, but to what degree? A detailed impact analysis assessment will determine how claims and electronic transactions will be affected by ICD-10 as well as the impact it will have on PM and EMR software.
Phase 3: Creating a Timeline and Transition Plan
The creation of a timeline and transition plan will support in guiding a practice through the various moving parts of a successful ICD-10 implementation. Create an ICD-10 transition project team with role specific tasks, deadlines, and accountability. Determine area-specific resource needs (human, technological and monetary), including a proposed budget.
Phase 4: Implementing your Transition Plan
Project Managers should plan for productivity loss before, during and after training. Learning and implementing new processes takes time and resources away from day to day duties. Set a date to begin the transition plan urgently. Coding professionals recommend beginning training on the actual codes 6 – 12 months prior to Oct. 1, 2014. Remember Phase 1-3 need to be accomplished prior to this phase so the time to begin is NOW.
Phase 5: Post Transition Analysis and Reporting
At this point, one can only speculate the requirements of the post transition phase, but monitoring key metrics will be invaluable in determining the results versus desired outcomes of the transition plan. Key metrics include revenue by payer, claims denials, and provider productivity. Monitoring and reporting key metrics will determine if course correction is needed.
With October 1, 2014 rapidly approaching, it is important that every physician practice and healthcare provider in America begin to take urgent action in completing the 5 phases for a successful ICD-10 transition.
ICD-10 Coach provides education, training, and software to hospital systems, physician practices, and health care providers. ICD-10 Coach is strategically partnered with over fifteen state and national medical associations and societies, and its software developer is an AdminiServe partner with MGMA-ACMPE. For more information on ICD-10 Coach, please call (650) 242-5442 or visit www.icd10coach.com.