Testing now is critical to ICD-10 readiness

Still not prepared for the switch over to ICD-10? Experts say there’s still time to catch up before the Oct. 1 compliance date.

In an ideal world, physicians, their coders, and office staff would have already fully assessed the cost of transitioning to ICD-10, would have undergone training about how to improve clinical documentation and appropriate use of the new diagnosis codes, and would have internally tested their upgraded software. That would leave more than half a year to complete external testing with health plans to ensure that they get paid in October.

The reality? Few are on track to meet those milestones on time.

"Everybody is behind, not just practices," said Robert Tennant, senior policy adviser at the Medical Group Management Association (MGMA). For a practice to be ready for ICD-10, the "key trading partners have to be ready and our surveys are indicating that they are not," he said.

Those partners include practice management software vendors, electronic health record (EHR) vendors, clearinghouses, and private and public payers.

So does that mean another ICD-10 delay is likely? The Centers for Medicare and Medicaid Services says no.

Part of the reason may be that health plans, which are investing money in upgrading their own systems, are pushing the agency to move forward on time. They are signaling to the government that they don’t want another delay, Mr. Tennant said.

The MGMA is advising its members to prepare for an Oct. 1 launch of ICD-10. But Mr. Tennant said he’s not entirely convinced that the CMS will stick to the date if much of the health care industry is unprepared to make the switch.

"Claims have to be paid," he said. "The system cannot grind to a halt because practices that aren’t paid can’t see patients."

Start with training

Assuming that most physician offices have assessed which parts of their practice management and EHR systems need to be upgraded, and have determined the cost for upgrades and training, it’s time to get familiar with the new diagnosis coding system.

Coders and billers will need the most training on the new coding methodology, but doctors still need to get familiar with the level of documentation that’s need for their most frequently used codes. In general, the new system calls for great specificity, though it’s not an absolute rule.

For instance, the classification for asthma has changed from ICD-9 to ICD-10. Physicians will need to provide more specific documentation about the severity level (moderately persistent, severely persistent, etc.) for their coders to select the appropriate ICD-10 code, according to Kathryn DeVault, a coding expert at the American Health Information Management Association (AHIMA).

"The good news is that as different as ICD-10 and ICD-9 are, they are similar," Ms. DeVault said. "If there’s a familiarity or comfort level working with ICD-9, it’s a natural transition to ICD-10."

While there are some significant changes, especially related to orthopedic codes, for many subspecialties the differences will be minimal, she said.

Ms. DeVault recommended having the practice manager or lead coder identify the top 20 diagnosis codes for every physician in the practice and build some education around those frequently used codes.

She cautioned doctors not to skimp on the time and money needed to thoroughly train themselves and their staffs. "The key here is to do it right and do it right the first time," she said.

Check the books

Physicians and their staff also need to evaluate their current cash flow and revenue cycle, including the age of account balances, billing lag time, and other issues that may result in delayed or denied claims, said Asia Blunt, practice management strategist at the American Academy of Family Physicians. Correct those problems now, she said, then reevaluate between April and August.

Experts at the AAFP are recommending that physicians put aside a cash reserve, if possible, to cover expenses during the first 3 months of the transition in case large numbers of claims are denied. (See below for more tips on planning for the worst.)

Testing with vendors, payers

Internal and external testing is also key. Before Oct. 1, practices should have completed end-to-end testing of their upgraded systems, ensuring that everything works smoothly from the time they code a claim to when they receive payment from the health insurer.

Practices can begin internal testing as soon as they have upgraded their software. But external testing will depend on when clearinghouses and health plans are ready.

The CMS will provide the first testing opportunity March 3-7. The agency will hold a national ICD-10 testing week allowing practices and clearinghouses to submit claims using the new coding system. Practices will receive an acknowledgement that the claims were either accepted or rejected by the system. Practices must register in advance through their local Medicare Administrative Contractor (MAC) website to test. Find your local MAC here.

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)

[email protected]

On Twitter @maryellenny

Still not prepared for the switch over to ICD-10? Experts say there’s still time to catch up before the Oct. 1 compliance date.

In an ideal world, physicians, their coders, and office staff would have already fully assessed the cost of transitioning to ICD-10, would have undergone training about how to improve clinical documentation and appropriate use of the new diagnosis codes, and would have internally tested their upgraded software. That would leave more than half a year to complete external testing with health plans to ensure that they get paid in October.

The reality? Few are on track to meet those milestones on time.

"Everybody is behind, not just practices," said Robert Tennant, senior policy adviser at the Medical Group Management Association (MGMA). For a practice to be ready for ICD-10, the "key trading partners have to be ready and our surveys are indicating that they are not," he said.

Those partners include practice management software vendors, electronic health record (EHR) vendors, clearinghouses, and private and public payers.

So does that mean another ICD-10 delay is likely? The Centers for Medicare and Medicaid Services says no.

Part of the reason may be that health plans, which are investing money in upgrading their own systems, are pushing the agency to move forward on time. They are signaling to the government that they don’t want another delay, Mr. Tennant said.

The MGMA is advising its members to prepare for an Oct. 1 launch of ICD-10. But Mr. Tennant said he’s not entirely convinced that the CMS will stick to the date if much of the health care industry is unprepared to make the switch.

"Claims have to be paid," he said. "The system cannot grind to a halt because practices that aren’t paid can’t see patients."

Start with training

Assuming that most physician offices have assessed which parts of their practice management and EHR systems need to be upgraded, and have determined the cost for upgrades and training, it’s time to get familiar with the new diagnosis coding system.

Coders and billers will need the most training on the new coding methodology, but doctors still need to get familiar with the level of documentation that’s need for their most frequently used codes. In general, the new system calls for great specificity, though it’s not an absolute rule.

For instance, the classification for asthma has changed from ICD-9 to ICD-10. Physicians will need to provide more specific documentation about the severity level (moderately persistent, severely persistent, etc.) for their coders to select the appropriate ICD-10 code, according to Kathryn DeVault, a coding expert at the American Health Information Management Association (AHIMA).

"The good news is that as different as ICD-10 and ICD-9 are, they are similar," Ms. DeVault said. "If there’s a familiarity or comfort level working with ICD-9, it’s a natural transition to ICD-10."

While there are some significant changes, especially related to orthopedic codes, for many subspecialties the differences will be minimal, she said.

Ms. DeVault recommended having the practice manager or lead coder identify the top 20 diagnosis codes for every physician in the practice and build some education around those frequently used codes.

She cautioned doctors not to skimp on the time and money needed to thoroughly train themselves and their staffs. "The key here is to do it right and do it right the first time," she said.

Check the books

Physicians and their staff also need to evaluate their current cash flow and revenue cycle, including the age of account balances, billing lag time, and other issues that may result in delayed or denied claims, said Asia Blunt, practice management strategist at the American Academy of Family Physicians. Correct those problems now, she said, then reevaluate between April and August.

Experts at the AAFP are recommending that physicians put aside a cash reserve, if possible, to cover expenses during the first 3 months of the transition in case large numbers of claims are denied. (See below for more tips on planning for the worst.)

Testing with vendors, payers

Internal and external testing is also key. Before Oct. 1, practices should have completed end-to-end testing of their upgraded systems, ensuring that everything works smoothly from the time they code a claim to when they receive payment from the health insurer.

Practices can begin internal testing as soon as they have upgraded their software. But external testing will depend on when clearinghouses and health plans are ready.

The CMS will provide the first testing opportunity March 3-7. The agency will hold a national ICD-10 testing week allowing practices and clearinghouses to submit claims using the new coding system. Practices will receive an acknowledgement that the claims were either accepted or rejected by the system. Practices must register in advance through their local Medicare Administrative Contractor (MAC) website to test. Find your local MAC here.

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)

[email protected]

On Twitter @maryellenny

Still not prepared for the switch over to ICD-10? Experts say there’s still time to catch up before the Oct. 1 compliance date.

In an ideal world, physicians, their coders, and office staff would have already fully assessed the cost of transitioning to ICD-10, would have undergone training about how to improve clinical documentation and appropriate use of the new diagnosis codes, and would have internally tested their upgraded software. That would leave more than half a year to complete external testing with health plans to ensure that they get paid in October.

The reality? Few are on track to meet those milestones on time.

"Everybody is behind, not just practices," said Robert Tennant, senior policy adviser at the Medical Group Management Association (MGMA). For a practice to be ready for ICD-10, the "key trading partners have to be ready and our surveys are indicating that they are not," he said.

Those partners include practice management software vendors, electronic health record (EHR) vendors, clearinghouses, and private and public payers.

So does that mean another ICD-10 delay is likely? The Centers for Medicare and Medicaid Services says no.

Part of the reason may be that health plans, which are investing money in upgrading their own systems, are pushing the agency to move forward on time. They are signaling to the government that they don’t want another delay, Mr. Tennant said.

The MGMA is advising its members to prepare for an Oct. 1 launch of ICD-10. But Mr. Tennant said he’s not entirely convinced that the CMS will stick to the date if much of the health care industry is unprepared to make the switch.

"Claims have to be paid," he said. "The system cannot grind to a halt because practices that aren’t paid can’t see patients."

Start with training

Assuming that most physician offices have assessed which parts of their practice management and EHR systems need to be upgraded, and have determined the cost for upgrades and training, it’s time to get familiar with the new diagnosis coding system.

Coders and billers will need the most training on the new coding methodology, but doctors still need to get familiar with the level of documentation that’s need for their most frequently used codes. In general, the new system calls for great specificity, though it’s not an absolute rule.

For instance, the classification for asthma has changed from ICD-9 to ICD-10. Physicians will need to provide more specific documentation about the severity level (moderately persistent, severely persistent, etc.) for their coders to select the appropriate ICD-10 code, according to Kathryn DeVault, a coding expert at the American Health Information Management Association (AHIMA).

"The good news is that as different as ICD-10 and ICD-9 are, they are similar," Ms. DeVault said. "If there’s a familiarity or comfort level working with ICD-9, it’s a natural transition to ICD-10."

While there are some significant changes, especially related to orthopedic codes, for many subspecialties the differences will be minimal, she said.

Ms. DeVault recommended having the practice manager or lead coder identify the top 20 diagnosis codes for every physician in the practice and build some education around those frequently used codes.

She cautioned doctors not to skimp on the time and money needed to thoroughly train themselves and their staffs. "The key here is to do it right and do it right the first time," she said.

Check the books

Physicians and their staff also need to evaluate their current cash flow and revenue cycle, including the age of account balances, billing lag time, and other issues that may result in delayed or denied claims, said Asia Blunt, practice management strategist at the American Academy of Family Physicians. Correct those problems now, she said, then reevaluate between April and August.

Experts at the AAFP are recommending that physicians put aside a cash reserve, if possible, to cover expenses during the first 3 months of the transition in case large numbers of claims are denied. (See below for more tips on planning for the worst.)

Testing with vendors, payers

Internal and external testing is also key. Before Oct. 1, practices should have completed end-to-end testing of their upgraded systems, ensuring that everything works smoothly from the time they code a claim to when they receive payment from the health insurer.

Practices can begin internal testing as soon as they have upgraded their software. But external testing will depend on when clearinghouses and health plans are ready.

The CMS will provide the first testing opportunity March 3-7. The agency will hold a national ICD-10 testing week allowing practices and clearinghouses to submit claims using the new coding system. Practices will receive an acknowledgement that the claims were either accepted or rejected by the system. Practices must register in advance through their local Medicare Administrative Contractor (MAC) website to test. Find your local MAC here.

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)

[email protected]

On Twitter @maryellenny