HIMSS News

ICD-10 waits for no man

Pam JodockBy the time this edition of Business Edge goes to press we will be days away from the “two-digit midget” milestone for the ICD-10 go-live date. Those of you who have continued your preparations despite numerous delays and uncertain endings should be in excellent position to make this a non-event for your organization. Even those who chose to stop their efforts when the 2014 delay was announced and resume them this year should be in pretty decent shape. Those who have put their preparations off as long as possible, hoping or believing that there would be yet another delay or that ICD-10 would be rejected altogether have a yeoman’s amount of work to complete between now and September 30, 2015 to ensure that they are as prepared as possible for the transition. 

Organizations that are well prepared will have already completed the following tasks:

  • Systems remediated to recognize ICD-10 codes for dates of service of October 1, 2015 or later, including pricing and business rules loaded and tested against claims submissions to ensure that systems are operating as intended;
  • Testing complete or well under way with business partners;
  • Internal coding staff trained and tested on the application of ICD-10 codes;
  • Medical team trained and tested on the use of more detailed documentation;
  • Procedural documentation updated to reflect references to ICD-10 codes for services delivered post-October 1, 2015;
  • Claims back-logs resolved to ensure organization is starting with “clean slate” at the time of transition;
  • Procedures established for monitoring pended and denied claims activity post-go-live to identify any unexpected spikes and respond immediately to resolve (these plans should include the engagement of your business partners);
  • Confirmation from business partners (clearing houses, external coders, payers, providers, etc.) that they are prepared for the transition (if you are concerned about a partner’s ability to support your success you may want to consider incorporating performance guarantees into your contract if you don’t already have them); and
  • Contingency plans in place to protect the organization’s financial position in case of temporary revenue disruptions.

This is not intended to be an all-encompassing list but it does include the major activities necessary to ensure your success.

Organizations that are just beginning their preparations should not panic. There are a number of resources available to help you get ready for ICD-10. CMS is offering free billing software through every Medicare Administrative Contractor (MACs) in the nation and more than half of those same MACs will be allowing providers to submit ICD-10 coded claims through their provider portals effective October 1, 2015. In addition, there are commercial vendors offering cloud-based claims coding and processing products that are purported to require very little set-up and training time. Availing yourself of these options still requires some advanced preparation; however, organizations will need to allow time for learning how to operate these options and train their staff. CMS has also said that they will accept paper ICD-10 claims from those organizations that apply and qualify for an Administrative Simplification Act Waiver.  

For additional information about what you should be focused on now to prepare for ICD-10, review the HIMSS ICD-10 Last Minute Check List or visit CMS’s Road-to-10 Website, or contact the HIMSS ICD-10 Speaker’s Bureau about delivering a presentation that will get you well on your way.

Pam has more than 25 years' healthcare industry experience. As the Senior Director of Health Business Solutions for HIMSS, she oversees the overall management and strategy development for HIMSS Health Business Solutions initiatives.