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ICD-10 checkpoint: Will six months be enough time?

By Jennifer Bresnick

You’ve heard it a million times over the past few weeks, but it still bears repeating: the ICD-10 deadline is just over six months away.  As the first quarter of 2014 draws to a close, and CMS insists that October 1, 2014 will be the big day no matter what, how is the industry progressing and what still needs to be done?

Internal and external testing remain a serious concern

Medicare may have bowed to some serious pressure when it comes to end-to-end testing with providers, but the vast majority of organizations will not have the opportunity to submit claims and receive real feedback before the transition date.  There is still a little bit of time to volunteer to be part of the end-to-end pilot test, but if you don’t make the cut, you’ll have to continue to coordinate the testing of your coding and data processing systems on your own.

Front-end testing is still available from CEDI if you’re worried about your Medicare claims being accepted, and your local Medicare Administrative Contractor (MAC) will likely have extra phone lines available in case you need to call for help.  But trying out your EHR and practice management upgrades is still squarely on your shoulders.  If you haven’t received your software updates by now, it’s time to start raising a ruckus with your vendors.  Six months is a tight time-frame, and you’ll have to cram in a whole lot of other activities concurrently if you want to meet the deadline.

Training and practice before go-live are essential

The official ICD-10 timelines from CMS suggest that comprehensive documentation and coding training should have started in January, and should continue until the very last possible moment.  Readying your staff for the big changes ahead is an essential piece of the transition puzzle, and it will require a coordinated effort across every part of your organization in order to succeed.  CMS has been releasing a new round of educational materials to help providers build momentum, and will also be hosting online training sessions.

However, the ICD-10 transition is a huge, complicated, and unruly beast to tackle.  Even small providers will need to make some serious investments in training, including finding the time during a busy work week to school coders and physicians on the new requirements.  Productivity losses and financial bottlenecks are two of the biggest anticipated problems with the transition, but the severity of the impact can be reduced when organizations plan ahead.

Many providers still lag behind…

As we push closer and closer to the deadline, industry experts are still cautioning providers that they are not making the progress necessary to see success in October.  A recent survey by MGMA highlighted these concerns, as well as the general lack of readiness, in a big way.  Clinical documentation integrity topped the list of worries, followed closely by productivity concerns and costs.  More than a third of providers don’t anticipate upgrading their software until April 1st, and just a tiny fraction have even started their testing.

…but payers seem ready to go

On the plus side, the major health plans seem to have everything well in hand.  Even non-HIPAA covered entities are well prepared for the switch, which brings hope to providers who depend on getting paid in a timely manner.  Medicare has been claiming total readiness since the Version 5010 conversion, and doesn’t anticipate too many technical hiccups.

What remains to be seen is how providers step up to the plate when it comes to the appropriate specificity and detail in their documentation, and how much leeway payers will give to providers as they learn how to navigate the new coding landscape.  While it’s in everyone’s best interests to keep the revenue cycle turning smoothly, there are bound to be some significant bumps along the road for certain organizations.

To avoid being one of the unlucky providers who experience more than a blip on the radar, use the next six months to pay serious attention to the way your physicians document encounters and how comfortable your coders feel with ICD-10.  Keep in contact with your business partners, vendors, and clearinghouses so you can monitor their preparations, and take advantage of the resources provided by CMS, professional societies, and coding experts in the run-up to October 1.





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