It’s mid-July, just two and half months out from the ICD-10 transition deadline. It’s clear now that there will not be another delay. It had also appeared that there wouldn’t be any concessions on the part of the Centers for Medicare and Medicaid Services (CMS). So it was a bit of surprise when they announced that they would offer some limited flexibility on claims.
Largely, those changes lighten the burden a bit on specificity and give practices a bit more time to get used to the much more detailed and specific coding that comes with ICD-10. Essentially, if the code is valid and in the right family of codes, it will likely be paid unless there is some other reason for a denial. It is too early to say if others payers will follow suit, but even if they do, it doesn’t really change the need for practices to get ready for the transition.
And there are a lot of practice that need to get ready, still. As I have been conducting trainings for ICD-10-CM, I have been surprised by the number of practices I have encountered who have done little or nothing to prepare. My personal experience has been backed up by a recent study that was just released. According to the Physician’s Practice 2015 Technology Survey, sponsored by Kareo, 26 percent of practices are not at all ready and 33% said they had started preparations but were not very close to being ready.
With only about 10 weeks left, which translates roughly to about 50 working days, that scares me a bit. There is a lot for practices to do and not much time to do it in. I have started recommending that practices that are wholly unprepared get help.
There are a few forms that help can take. First, getting clinical documentation improvement (CDI) specialist in to work directly with providers to improve their documentation to meet the standards for their specialty for ICD-10 can be a huge help. Another option is to bring in a consultant to help with a coding audit, running top codes reports, and conducting code mapping. That person may also be able to offer some CDI services.
At this point, however, that just may not be enough. If your practice isn’t prepared, especially if your billing person or team is not ready, you may need to consider outsourcing. A medical billing service can provide ICD-10 trained billers and certified coders who are already prepared and you can probably find someone with experience and ICD-10 training in your specialty. Often, a service can provide a level of best practices that many practices lack. This is particularly true around managing denials, which will be critical after October 1.
Even with the leniency on specificity, your ICD-10 coding still needs to be valid and accurate to get paid. Prior to the announcement from CMS, experts were predicting a rise in denials of as much as 200%. I’d expect to still see an increase as practices adjust. According to MGMA, only 35% of practices follow up on denials now. This could be a huge barrier to getting paid when ICD-10 kicks in.
Outsourced billing is often more affordable for smaller practices since the billing service only gets paid based on what is collected. In the case of ICD-10 this is an incentive to help ensure the practice is prepared, closely monitor claims from submission to payment, and manage any denials, rejections or other issues.
If you do opt to outsource, just remember it isn’t a fix all. You still need to train your staff, improve documentation, update forms and policies, double check your payer contracts for any ICD-9 references, and set aside some cash reserves—or get a line of credit—to get you through the transition.
On the flip side, if you choose not to outsource, I strongly recommend using an integrated EHR and billing system that offers tools to help prepare for and manage ICD-10. Your chances of making mistakes are much higher on a paper superbill that has to be manually entered, not to mention the fact for some an ICD-10 superbill will be unmanageably long.
Whatever choices you make, remember that the status quo won’t cut it. There are changes you have to make if you want to get paid after October 1. If you are in the one quarter of practices that haven’t done anything, start today!
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