Is Your Organization Ready for ICD-10? Important Questions to Ask


After several years of delays, the compliance deadline for ICD-10 is looming. On October 1, 2015, all HIPAA-covered entities will be required to use the new, more specific codes when coding medical diagnoses and inpatient procedures.

Is Your Organization Ready for ICD-10? Important Questions to Ask

While ICD-10 has been coming for a while, the numerous delays have led many organizations to put transition efforts on the back burner. In fact, one industry survey of 1,100 providers indicates that more than half aren’t ready for the compliance deadline. The Centers for Medicare and Medicaid Services (CMS) has eased some anxiety with its recently released ruling that providers will have a one-year “grace period” on the new coding system, and won’t experience denied Medicare claims and delays in payments due to errors in coding, but those provisions don’t necessarily extend to private insurers.

The fact is, ICD-10 is going to become reality in about two months, and providers who want to continue to successfully submit claims and avoid disruptions or delays in providing care — and being paid for that care — need to take steps to prepare now.

Part of determining readiness for ICD-10 includes asking some important questions, of both vendors and staff.

Are Your Vendors Ready?

According to the Medical Group Management Association, many providers have not yet had their electronic medical records and coding software upgraded to meet the new ICD-10 requirements yet. MGMA surveys indicate that as many as 25 percent of smaller practices are still using older practice management systems that cannot generate the more complex codes required under ICD-10. This is despite a federal mandate issued in 2012 that required all practices to upgrade to the new Version 5010 messaging standard, which has the capability of generating the appropriate codes. However, problems with the software — and the costs associated with the upgrades — have kept some practices from adhering to the mandate.

CMS recommends that providers reach out to their vendors, if they have not already done so, to ensure that they are compliant or ready to be compliant before the October 1 deadline. The agency has developed a Technology Vendor Assessment that providers can submit to their vendors to get answers to key questions. At minimum, you need to determine if your vendors’ products:

  • Are your products impacted by ICD-10, and if so, how?
  • Are upgrades available to make current products ICD-10 compliant?
  • What additional fees and costs are associated with ICD-10 compliance?
  • What type of training, testing, and support is available?

If upgrades aren’t available, you will need to identify alternative solutions. Having a backup in place is a good idea, anyway. CMS has developed a list of vendors, including those of home health software, who have self-reported their readiness, and if your current vendors cannot demonstrate compliance, purchasing a new system may be in order. Other options detailed by CMS include using free or online claims services, outsourcing billing operations to a compliant company, and using paper submissions.

Are You Medicare and Medicaid Compliant?

Is Your Organization Ready for ICD-10? Important Questions to Ask

If your practice has already upgraded or installed ICD-10 compliant systems, you aren’t done. Medicare and Medicaid also have requirements that need to be met, and they depend on individual state agencies. Even if your vendor is compliant with new ICD-10 regulations and you’ve completed internal testing, you may have additional requirements to meet in order to submit claims to state agencies.

Are Your Employees Ready?

Getting the technological aspects of the ICD-10 transition squared away is only part of the transition process. Many coders and medical billing professionals are concerned about the effect that the new codes will have on their productivity. For that reason, the American Health Information Management Association has offered some guidelines for providers to make the transition go more smoothly before the compliance date. Among the AHIMA recommendations include:

  • Intensive training. Many providers have sent their coders to training sessions, but AHIMA notes that a few days of training in a classroom may be inadequate. They recommend that the billing team practice dual coding — creating claims in both ICD-9 and ICD-10 — for at least a few charts each day to get familiar with the new procedures.
  • Implement new technologies. The ICD-10 transition has led to the development of several new applications and tools to help coders make the adjustment. Work with your coders to identify and implement tools that will make their jobs easier.
  • Build your team. To help ease the transition, busy offices may opt to hire more coders, even part-timers, to help keep up with the volume of work and prevent backlogs.

While the delays in ICD-10 implementation may have lowered the change’s position on your priority list, it’s now time to move it back up to a top priority. Spending the time now to ask the right questions and get everything in place with make the transition as seamless as possible.

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