“Make sure that any quality-reporting tools you are using are integrated and interfaced with the ICD-10 code set, so those quality reports are translated cor- rectly to the Centers for Medicare & Medicaid Services or to the Centers for Disease Control and Prevention.” Step 5: Conduct internal testing (minimum time to complete: two months). Once the upgrades are com- plete, staff should conduct internal test- ing to ensure the upgraded systems can generate transactions with the ICD-10 codes. Practices should allow extra time for troubleshooting and working with vendors to address any obstacles. Step 6: Update internal process-
es (minimum time to complete: two months). Internal processes that support coding need to be updated, as well. These include superbills, encoun- ter forms, quality data collection forms, and public health data collection forms. Physician offices should take this time to review clinical documentation to ensure it captures the necessary details of pa- tient diagnoses. “The concept of the one-page super-
bill may pretty soon be outmoded,” Dr. Spain said. “When your diagnosis set has expanded so dramatically, you prob- ably can’t list them all to make it read- able. Most physicians will probably want to keep a cheat sheet of the most com- mon diagnoses they use, so they don’t have to pick up the ICD-10 manual ev- ery 10 minutes.” Dr. Spain said some physicians may
feel as if the switch to ICD-10 is pushing them to adopt EHR systems. “If you’re part of a big group, you
won’t have much choice but to go with the flow and adapt (if they adopt an EHR),” he said. “If you’re by yourself and plan to retire in four or five years, you may just do what you can to get by without investing a lot.” To help physicians anticipate the changes ICD-10 will bring to the office environment, the AAPC website includes an illustration (
www.aapc.com/ICD-10/ office-map/
index.aspx) that shows how all parts of a typical practice will be af- fected — from revising privacy policies and creating and ordering new forms to
28 TEXAS MEDICINE February 2012
ensuring your coding staff has a more detailed knowledge of anatomy and medical terminology. Step 7: Conduct staff training (minimum time to complete: two months). The transition to ICD-10 is definitely an “all hands on deck” event. Training should be readily available for every staff member. The training times should be staggered to prevent down time in the practice. Coding staff may want time to practice using the ICD-10 code set on sample claims, such as cur- rent claims, before the compliance date. “Complete training in phases, and
make sure to address all staff training needs,” Ms. Buckholtz said. ICD-10 training services and resourc-
es are online at
www.texmed.org. Addi- tional ICD-10 information and guidance are available through multiple Texas health insurers and the Centers for Medi- care & Medicaid Services. (See “Insurers Prepare for ICD-10,” pages 34–36). Step 8: Conduct external testing
with clearinghouses, billing ser- vices, and payers (minimum time to complete: six months). During this step, offices should conduct exter- nal testing with their payers and billing services or clearinghouses to ensure that they can properly send and receive ICD- 10 codes in transactions. Medical practices should expect pos- sible increases in rejected claims or a slowdown in their coders’ and billers’ productivity during this step. It is im- portant to undertake this testing in time to work out any remaining issues and to give staff time to work with the codes before the deadline. Step 9: Make the switch to ICD-
10 (deadline: Oct. 1, 2013). All ser- vices and discharges on or after Oct. 1, 2013, must be coded with the new ICD- 10 code set. ICD-10 codes will not be ac- cepted before Oct. 1. Moreover, payers will reject transactions that continue to use the ICD-9 codes after Oct. 1, 2013. Medical offices should continue to monitor the submission and receipt of transactions to ensure everything is working properly. They also should re- view reimbursements to determine if the amounts align with the services billed.
“If there are any problems, talk to your vendor immediately,” Ms. Moore said.
Readiness challenges Unquestionably, the transition to ICD-10 will be time-consuming and multifac- eted, said Ms. Bettridge. Its implemen- tation will add layers of complexity to daily operations.
“Physicians and staff will have to jug-
gle this change along with all the other daily operational challenges they already face,” she said. “For many practices, the cost of implementation is still uncertain and they may experience difficulty in getting staff and physicians on board. Underlying all of this is the real possibil- ity of revenue loss.” Dr. Spain echoes these sentiments. “For most of us, [the transition to
ICD-10] has taken a backseat to keep- ing abreast of medical changes. Yet, this is probably the most profound, far- reaching coding and billing change that there’s ever been,” he said. “I think phy- sicians will be surprised at how perva- sive the changes will be and how much it is going to affect their work flow.”
Liz Carmack and Katie Ford are freelance writers in Austin.
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