CHICAGO – Between now and the Oct. 1 ICD-10 transition, physicians should examine their past claims, reduce backlogs, and develop contingency plans to address unforeseen challenges, Betty Gomez said at the annual meeting of the Healthcare Information and Management Systems Society.
Physicians “think about Oct 1, 2015, and we think, ‘OK, all of my [preparations] are done. Great,’ ” said Ms. Gomez, a regulatory strategy consultant based in Louisville, Ky. But “Oct. 1 really marks the beginning of you ‘operationalizing’ your work and living in an ICD-10 world. It doesn’t stop there. It’s just the first milestone.”
Alicia Gallegos/Frontline Medical News
F. Phil Cartagena speaks at the 2015 HIMSS annual meeting. Also pictured are speakers Betty Gomez, left, and Jon Melling.
Over the next 6 months, physicians should assess their coding systems and ensure they are fully prepared to work efficiently when ICD-10 goes live, Ms. Gomez said. A first step is getting a handle on the number of pending and denied claims. If an excess of pending claims exist, work immediately to lessen that excess.
“With the transition, there are going to be unforeseen obstacles and challenges,” she said. “You don’t want to have a pile and then be piling on top of that.”
Ms. Gomez recommended creating ways to monitor performance and develop thresholds for success. Benchmarks can help determine what success looks like and what issues should trigger concern. As Oct. 1 approaches, have a checklist in place to ensure all necessary tasks are completed. Questions might include: Do I have a response team or designated staff member in place to address potential problems that arise on or after Oct. 1.? Are staff members educated on when to use ICD-9 and when to use ICD-10 codes after the transition?
“You need to make sure you can continue to use both ICD-9 and ICD-10 codes, based on date of service or date of discharge,” Ms. Gomez said. “Verification is so important. You can never go wrong with making sure everything is in order.”
In terms of financial preparation, discuss with the practice’s top payers what kind of contingency plans are needed to ensure their revenue remains sufficient after Oct. 1, said F. Phil Cartagena Jr., ICD-10 program manager for Partners Healthcare System in Boston. The general recommendation is that practices have a minimum of 3 months of cash flow on hand, Mr. Cartagena said in an interview. However, it’s beneficial for practices to work out agreements in which payers match or partially match physicians’ current monthly run rate during the transition. Such arrangements can help mitigate claim denials that take time to be adjudicated, thus delaying cash flow.
“Your business isn’t going to change,” Mr. Cartagena said. “The patients that you’re seeing and the things that you are doing aren’t going to radically change, but if the ability to properly account for them and get paid for them changes, you don’t want it to have a major impact to your bottom line.”
Mr. Cartagena also suggested that physicians start more extensive patient documentation now, rather than waiting until ICD-10. As most physicians know, the nearly fivefold increase in the number of codes also requires more specific documentation than did ICD-9.
“The more specific that you can be, the better it is, whether it matters for actually coding the record correctly, or if it’s for stratifying your patient mix or having a better understanding clinically of how the diagnoses of your patient population break down,” he said. “It all comes back to the more information you have on the patients, the better they can be coded, and the better information you get at the end of all of it to understand your mix.”
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