Mandates apart, descaling of operational vulnerability is the key to successful functioning of a healthcare enterprise. In other words it might put one (read as a provider or a practice) at dismay when the wrong codes resulting in inappropriate procedures. This creates a detriment to the human lives and leaving an irreconcilable billing ambiguity. Conceive it as a common sense issue, put yourself on the providers’ saddle and “realize”, with much less commotion this can be in the direction of a viable solution.
As the US healthcare industry faces yet another delay in ICD-10-CM/PCS implementation, with a new compliance date of October 1, 2015, questions continue to arise as to whether there are any alternatives for replacement of ICD-9-CM other than implementation of ICD-10-CM/PCS. In particular, use of SNOMED CT or waiting for ICD-11 is both alternatives that have received attention. This article addresses why neither of these approaches is a reasonable alternative to implementing ICD-10-CM/PCS, and why the US must remain fully committed to transitioning smoothly to ICD-10-CM/PCS on October 1, 2015 while leveraging the exciting opportunities presented by this transition.
Getting to ICD 10
ICD-9 is outdated today and continuing to use the outdated codes limits the ability to use diagnosis codes to advance the understanding of diseases and treatments, identify quality care, drive better treatments for populations of patients, and develop new payment delivery models. There are close to over 14,000 ICD 9 codes or thereabouts that is waiting for transition into the new world of over 70,000 ICD 10 codes. The granularity defines the correspondence of the right codes to the right disease classification, best said. While the intent is to bring the billing errors to naught, the closest target is to achieve as much accuracy as possible when the billing mismatch can make a significant impact on the revenue cycle. Many providers are oblivious to the ICD transition and could result in a bad code participating in the billing process. When the role of clearinghouses are expected to be a crutch in ideal cases where direct transactions cannot be supported, the initiative to reduce the use of clearing houses becomes emphatically imperative, one, for latency reason and two, for cost reason. Many practices are not fully cognizant of the risks to their financial health, though inadvertently, because of the transition program from ICD 9 to ICD 10 is yet to embark.
Catch the ICD 10 sooner
Financial viability will remain protected if you prepare for the ICD-10 transition long before the current Oct. 1, 2015 deadline. It is highly recommended that you implement an ICD-10-ready solution as soon as possible, which can help test your system and orient your staff to the new code set. With the right assistance there are already practices using ICD-10 codes and of instead of dreading ICD-10, you’ll look forward to its implementation date as a day like any other. There are higher complications to throw you out of gear when a procedure needs to mapped to multiple ICD 10 codes. This underscores the need for early testing. Healthcare providers need to take a diagnosis through the entire process to make sure they will be get reimbursed. A sophisticated and most productive EHR won’t do any good if the information doesn’t make it on to a bill or medical claim.
ICD 10 preparation by the healthcare payers will have their share of ramping up their infrastructure to fall in line with the providers by updating the software, systems and the procedures by now. In addition, they should work on building comprehensive test plans with the goal testing it over a five to six month period. It is also required for the payers to keep the providers educated.
ICD-10: Planning your purse strings
Not to be caught by surprises, it is important to know various costs associated with the entire transition program. Primarily your budget should include both the direct and indirect costs. From the providers’ viewpoint direct costs would involve software upgrade, physician training and the consultant fee. Indirect costs can be consequence of drop in productivity while the transition is in progress and the increased accounts receivable cycles due to the expected learning curve associated to using the system and new set of codes
Roadmap and assistance through Regional Extension Centers (REC)
Many organizations, especially smaller ones, could use additional education or other assistance in their compliance efforts. The regional extension centers (RECs) currently funded by ONC could be used in this regard. There is also a large volume of industry materials available that could be useful, however organizations may not be aware they exist. An outreach and awareness campaign could prove useful
Encourage an effective private sector testing process
It is not practical or feasible for every provider and payer to test with each other. Rather than trying to conduct a massive end-to-end industry testing process, it would be more beneficial to establish selective testing processes that illustrate that each key function is working correctly. For example, testing a key subset of claims for provider specialties could illustrate to each specialty that those claims are being processed correctly. Results of this testing should be shared so that it would not be necessary to test with every provider of that type. For outpatient facilities, it may prove more useful to test eligibility and prior authorization functions than to test the procedure-based payment process that has been in place for many years. Clearinghouses might be leveraged in testing, as they have direct connections to most large payers and many provide reports on key performance indicators that can be used to identify aberrations under ICD-10
Where does it take us?
Implementing ICD-10-CM/PCS is an important step on the pathway to ICD-11. ICD-10-CM has informed ICD-11 development, as updated clinical knowledge and additional detail considered important for use cases such as quality and patient safety monitoring have been incorporated into the US code sets. Transitioning to ICD-10-CM/PCS in 2015 will provide an easier and smoother transition to ICD-11 at some point in the future. By preparing information systems now to accommodate ICD-10-CM/PCS, they will be better able to accommodate the transition to ICD-11. And just as modifications to ICD-10 have been incorporated into ICD-10-CM through the annual update cycles, it is anticipated that content additions in ICD-11 that are not already included in ICD-10-CM will be incorporated into ICD-10-CM over time, which will facilitate the transition to ICD-11. Due to the structural limitations and obsolescence of ICD-9-CM, modifications to ICD-9-CM to reflect changes in the World Health Organization version of ICD would be impossible, complicating and disrupting a future transition to ICD-11 if the ICD-10-CM/PCS code sets are not implemented first.
Telliant can make the complex simple
Building an ICD-10-ready application is the single and most important task for coding in ICD 10. Telliant’s ICD-10-ready solutions empower you and your staff with the tools and support you need to successfully transition your practice to the new code set. Our ICD-10-ready solutions include, Integrated ICD-10 mapping and integrated clinical vocabulary so that you may continue to code in both ICD-9 and ICD-10 while your payers catch up, filters to help you easily select the correct code and education and training resources for you and your staff. With our 24X7 services operations across the India and US shores you can accelerate your adoption.