Summer is nearly here and, for many, that means sunshine, barbecues and vacations. But in just 4 months, the annual autumnal return to normalcy might seem more harsh than usual: the time to transition to ICD-10 will finally be here.
The International Classification of Diseases, or ICD, is used to standardize codes for medical conditions and procedures. While most countries already use the 10th revision of these codes (or ICD-10), the United States remains the only major industrialized nation that has yet to adopt this convention. The country’s healthcare system is still using ICD-9 although, at more than 35 years old, the coding standard is woefully out of date. Furthermore, ICD-9 contains obsolete terms that are inconsistent with current medical practice, limits the number of new codes that can be created and, in fact, does not have space for new codes in many categories.
ICD-10, on the other hand, provides room for generation of new codes that are reflective of current diagnoses and treatment pathways, which will allow for better support of patient care, and improve management, data capture, quality measurement and analytics. The transition to ICD-10 — which has already been delayed more than once, most recently by a full year — is much-needed to accommodate the rapidly changing U.S. healthcare system.
But that doesn’t mean it’s going to be easy. Here are some steps you can take now, to ensure that you’re on track for the conversion, scheduled to go live on October 1.
1. If you haven’t already, it’s time to review each compliance step and prepare a schedule timeline to meet each component. The Centers for Medicare and Medicaid Services (CMS) have a dedicated site with tools for building the plan for your transition, based on your type of facility, provider type and more. Brief or refresh the relevant staff on the schedule and how they will be involved.
2. Work with your electronic health record (EHR) vendor to ensure that your EHR system has the necessary capabilities to handle ICD-10 codes. The system should be able to have ICD-10 codes at the ready, be able to manage the input of new or lesser-used ICD-10 codes, and generate correct, easily usable documentation to the coding and billing department. You may need to allocate budget for upgrading technology or investing in new software resources.
3. Train staff on ICD-10. The new standard is more than just a set of diagnosis codes, they will also help guide treatment on the front end, and affect the way data are gathered and analysed on the back end. Coding and billing staff should already be becoming familiar with what this will mean for their roles, as part of ongoing education to stay certified. However, clinical staff may need more outreach. One method that can help advance their ICD-10 transition is hiring scribes, who will already be trained on ICD-10 and familiar with how it will work in practice.
4. Develop your daily protocol for how ICD-10 will work in practice. This means setting out the roles and responsibilities for each staff member (whether clinical or business side), for each patient encounter. This also means adjusting “payment scheduling and reimbursements to avoid claim denials,” and conducting “external testing with … payers to make sure” ICD-10-coded transactions can be sent and received. Finally, each practice should identify the codes that will be used the most, and filter those for quick and easy access in the EHR system.
The implementation of ICD-10 will have numerous benefits: improved care coordination across providers, support quality-of-care payment initiatives, enhance fraud-detection efforts, and more. At this point, further delaying the ICD-10 transition date would be costly to providers and all healthcare sectors. Now’s the time to make sure — or double-sure — that you’ll be ready come October 1. And, look on the bright side: At least you won’t have to start rumblings about another transition, to ICD-11, until 2017 at the earliest.