On October 1, 2014, medical coding in U.S. healthcare settings will change from ICD-9-CM to ICD-10-CM. In a best practice world, healthcare organizations should already be executing their ICD-10-CM implementation action plans. Many hospital systems are showing active progress given the more direct financial relationship between ICD-10-CM and inpatient reimbursement. However, now is also the time to prepare from the physician perspective. To help get started, provided below are some essential steps to prepare for ICD-10-CM (with areas of emphasis in bold):
- Organize a Team
- Include all areas/roles (e.g., providers, managers, coding and billing staff)
- Determine the Method of Communication
- Develop a communication schedule (e.g., regulatory updates, training events)
- Analyze Organizational Impact
- Determine what systems will be affected
- Develop a timeline for the implementation process
- Determine work processes involved (e.g., systems, policies and procedures)
- Develop a budget (e.g., hardware, software, training and staffing costs)
- Inquire and Collaborate with Vendors
- Learn what steps they are taking regarding ICD-10-CM preparedness
- Determine how to reduce duplication of efforts
- Determine High Impact Areas
- Determine most frequently-billed diagnoses
- Review diagnoses associated with medical necessity denials
- Review payment policies (e.g., coverage determination diagnosis requirements)
- Assess need to retool provider superbills/encounter forms
- Evaluate Productivity/Staffing Impact
- Determine current baseline coding productivity levels
- Estimate staffing impact (e.g., determine additional resource needs, if any)
- Evaluate Revenue Cycle Impact
- Determine payor/vendor conversion requirements
- Assess short-term and long-term financial impact (e.g., days in A/R, held claims, increased DNFB, denials and related resubmissions)
- Develop Training Plan
- Who? Determine areas/roles (e.g., providers, managers, coding and billing staff)
- What? Develop materials
- When? Determine schedule (e.g., six months to one year before implementation)
- How? Determine method (e.g., in-person, web-based, audio)
- Formal ICD-10-CM Implementation: Preparedness to Readiness to Go Live
If you would like additional information on ICD-10-CM, please contact the experts listed below at PYA, (800) 270-9629.
