But this type of front-end testing is only a first step, Mr. Tennant said. Front-end testing determines whether the claim contains an ICD-10 code and if it is in the right place and the right format. But practices will need to conduct further testing with payers to determine if the code they used is appropriate and whether they will get paid.
For instance, when submitting a claim for a sprained ankle under ICD-10, the coder might specify right or left ankle, or leave it as unspecified. Depending on the health insurer’s policy around the code, the insurer could pay the claim, reject it, or hold or "pend" it while seeking additional information. The complicating factor, Mr. Tennant said, is that each health insurer has different coding policies and those policies have yet to be released for ICD-10.
"It’s very frustrating for everybody," Mr. Tennant said.
To minimize the impact, Mr. Tennant recommended identifying the payers responsible for the majority of your claims. Keep in contact with them about the release of their payment policies and testing schedules, he said.
"Be aggressive in your outreach to those plans," he said.
Contingency plans
Just in case a worst-case scenario develops, Mr. Tennant offered the advice on ICD-10 contingency plans:
• Research back-up options for practice management systems and clearinghouses. If the vendors aren’t providing a clear answer on when they will be ready to offer upgrades and testing, start researching alternatives. Ask colleagues if they have vendors that are prepared for the transition.
• Don’t rely on one coder. Train more than one staff member on how to use the new coding system. That way, if the chief coder leaves 3 weeks before the compliance date, someone else can step in.
• Limit vacations around the Oct. 1 compliance date. This is not a time to operate short staffed.
• Don’t wait around for health plans to start ICD-10 testing. Start with context testing. Take a subset of high-dollar, high-volume ICD-9 claims that have already been paid by the health plan and practice coding them in ICD-10. Similarly, begin to code claims in parallel in both ICD-9 and ICD-10 and move them through your internal workflow. In both of these testing approaches, check if the documentation provided is sufficient to identify the best ICD-10 code. If not, it’s time for more training.
• Ensure you have enough cash to operate in case claims are rejected or delayed. Setting aside cash reserves is a good move. Consider postponing major capital investments for a few months before and after Oct. 1. Obtaining a line of credit to cover a few months of operating expenses is another option.
• Submit as many of claims as possible with ICD-9 codes before Oct. 1.
Free ICD-10 resources
• ICD-10 guide with checklists and timelines (CMS).
• Sample letter to gauge vendors’ ICD-10 readiness (AHIMA).
• Cost calculator and ICD-10 timeline (AAFP).
• Twelve step transition plan, white papers, and practice tool (AMA)
mschneider@frontlinemedcom.com
On Twitter @maryellenny