The deadline for the transition to ICD-10 is sneaking up on us:
October 1, 2015 is just a few months away. As a medical practice or health care group, it is important to take precedence in starting these tests for a smooth transition in order to minimize service disruptions and avoid losing reimbursement on claims. This extension from last year should enable practices to undergo rigorous and proactive testing and ensure a higher success rate.
According to the Healthcare Information and Management Systems Society (HIMSS), billing providers are going to change due to “significant changes in the code set(s) required for reporting services.” This transition will require sound communication and participation with all parties involved in the healthcare industry – from providers, health plans, and clearinghouses.
With all of that information in mind, here are 3 reasons why starting your ICD testing now will benefit your medical practice and staff:
1.) More Data Means More Money
The more information you have about the projected metrics of ICD-10, the better chance your claims won’t be denied and you will receive maximum reimbursement. HIMSS refers to this as “revenue impact analysis,” and it is invaluable to combatting the possibility of “negative changes in reimbursement” that may happen as a result of ICD-10.
Of course, errors are bound to occur, but that is where gathering data and analysis is going to be paramount when your staff conducts these tests. Figure out your largest payers and the ones that impact your revenue cycle the most (the 80/20 rule). Then, communicate with them about your intent to test – by taking existing claims and submitting them with ICD-9 and ICD-10, you will be able to have a control/baseline with ICD-9 and compare discrepancies and process adjustments to ICD-10.
However, some may have specific parameters in place, and it’s important to learn these requirements to better accommodate testing scenarios. This will help facilitate your data, so you can create a list of what works and what doesn’t based on your control/baseline.
In short, you will be ahead of the curve by testing with ICD-10 now, and will be equipped with the necessary information for coding changes and quicker reimbursement for each payer with the metrics you gain.
2.) Avoid Delayed Reimbursement
As stated above, communicating with your payers will help you create a control/baseline to follow. By waiting to test, you risk this communication with your health plans and clearinghouses becoming lapsed due to an overwhelming volume of requests they will be receiving as ICD-10’s deadline looms.
As a result, your claims may be denied due to lack of information or correctness from adjudicators (“those that process and/or adjudicate healthcare claims”). This is completely preventable by developing a rapport with those that handle these claims (spanning from multiple different companies).
Some payers may not even have a system in place as to how they are testing claims. This is where you come in— to help coordinate testing with them and your staff and discuss ways afterwards on how to improve the process (hint: this will also help you get paid faster!)
This not only helps them, but it helps your claims and brings forth a sense of visibility for your practice. Only good can come from maintaining optimum communication with your payers and/or clearinghouses. Doing so will ensure you are aware of the data you’ve compiled; regularly doing this until and during ICD-10 will set you up for success.
3.) Prevent System Overload
Most likely, your system software that handles patient information, coding, and reports functions a specific way to abide by the current systems in place. By using this ICD-9 “special processing or decision logic,” it will require reconfiguration to ICD-10 rules and policies.
Your systems will need to be tested both internally and externally on all of its processing and interfacing. Why wait until ICD-10 is required to know what upgrades and changes your software will need? This software will need to be monitored and tracked, since most system programs work separately to form an integrated whole.
Don’t leave your staff ill-prepared, as this will make the transition even more difficult. By beginning to test now, you will familiarize your staff with software discrepancies and become proactive and productive as the change occurs.
ICD-10 testing will benefit your practice in the long run, both for your patients and your staff. By seeing these benefits, hopefully you will be prompted to begin your own testing and prepare everyone for the changes that are approaching this fall. If not, you risk falling behind and will run into problems.
So, by now you should be able to answer this question – Are you ready to start testing for ICD-10?