Tag Archives: ICD 9 to ICD 10

Failing to Prepare for ICD-10 is Preparing to Fail: Part III of III

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The Coming ICD-10 Cash Flow Crisis and How to Avoid It

By Terry Kile, Senior Sales Executive, BridgeFront

The transition to ICD-10 will not be without its issues.

Mona Engle, RN, CEO/Practice Administrator of Drs. May Grant Associates, is concerned about coding outcomes. “If something is not coded correctly, the insurance company will not pay — so we have to do it right…The ICD-10 transition will [be] a difficult and costly endeavor,” she says.

By nine months from your deadline, your team should be documenting, coding and billing in both ICD-9 and ICD-10. For most of us, that timing falls around the end of 2013. Beginning the process of dual coding should consist of:

• Chart review by an ICD-10 trained medical coder to help you identify documentation needs for ICD-10.
• Increased training for the entire team.
• Implementing changes to processes and forms pertaining to your present coding and billing procedures.

At first, your coders may spend many hours “crosswalking” codes. That is, doing a side-by-side comparison of an ICD-9 code to its closest match in ICD-10. This is a challenge when the ICD-9 code for Extrinsic Asthma-unspecified (493.00) has 16 different code choices in ICD-10. Making the correct choice requires additional documentation detailing a number of factors.

“Crosswalking” requires referencing coding books, which is time consuming, so several software options are now available to make this process more efficient. Check out Simple Solutions, from Complete Practice Resources, or have your coders use ICD-10 Code Search, found online here.

Another key to success is communicating with all system vendors and business partners that use DRG codes to receive and send data to your systems. These may include pharmacies, labs, your EHR, etc. This is imperative to complete as you approach the deadline because a vendor’s plan for conversion to ICD-10 will directly affect your bottom line.

Some practices and hospitals are planning to test for internal ICD-10 compliance a full six months before the deadline, probably long before most of their external partners are ready to convert. If your vendors are not ahead of the game, you will need to develop conversion strategies or risk losing cash.

The ICD-10 transition is challenging, but it is not impossible…and it doesn’t end on October 1, 2014. Your ongoing job is to make sure that cash flow over the first three months of the new processes is affected as little as possible. Be ready to do immediate charting, coding and billing triage during the last half of 2014 and to immediately change the systems, habits and processes responsible for any problems. Ongoing issues cost very real money.

Reach out to industry organizations, professionals and your vendors to help make this transition a success. We are all trying to work as fast as we can to ensure that your practice come through this process with as little loss as possible. With your devoted time and attention, we can make that happen.

Terry C. Kile is a Senior Sales Executive for BridgeFront, an online education provider for healthcare. For information about BridgeFront, go to www.bridgefront.com. Contact them directly by calling 1.866.447.2211.


Failing to Prepare for ICD-10 is Preparing to Fail: Part II of III

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The Coming ICD-10 Cash Flow Crisis and How to Avoid It

By Terry Kile, Senior Sales Executive, BridgeFront

How can your practice avoid having cash flow issues in the last part of 2014? It will take planning, training and support from your employees, partners and vendors. This will certainly not be solved with a simple EHR software change—especially since you don’t yet know when or if your EHR vendor will be ready to test ICD-10 documentation and codes prior to October 1, 2014.

To begin, choose a person in your practice to head the process—it may be your practice manager or one of your partners. Their qualifications should include a thorough understanding of the complexity and financial significance of the ICD-10 transition, someone who can delegate effectively and motivate others to accomplish their assignments, and one who will hold others accountable if they do not.

Your “internal champion” may even be a committee, as long as one person is responsible for the entire transition. When you look into the tasks involved, you may feel as if you don’t have anyone available to take on the assignment. That’s okay, too. While you need still need an in-house point person, the champion may very well be an outside consultant.

Training is the next step in the process. Besides the obvious training needed for medical coders, physicians also need to be brought up to date as soon as possible. The earlier you start training, the more frequently your team can train on the material, and the earlier you can begin dual coding. Dual coding (the process of coding patient encounters concurrently in ICD-9 and ICD-10) will provide you with an overview of what needs to be fixed prior to the deadline. Online training alternatives let staff learn remotely. An inexpensive set of courses is provided by BridgeFront.

Frank Musso, of Francis C. Musso, CPA, MPA, P.C., notes that “the move to ICD-10-CM will increase documentation activities for medical support staff and physicians. This is a permanent change, not a learning curve change, and translates into an increase in physician time spent on documentation for ICD-10-CM with no expected increase in reimbursement.”

Planning the transition process for your practice takes time, and your team lead may not have enough time to work out the schedules, milestones and assignments required. Several simple project management software programs and whitepapers are available to simplify and accelerate the planning process, among them The ICD-10 Checklist from AHIMA.

Stay tuned for Part III of this ICD-10 blog series next week!

Terry C. Kile is a Senior Sales Executive for BridgeFront, an online education provider for healthcare. For information about BridgeFront, go to www.bridgefront.com. Contact them directly by calling 1.866.447.2211.


Failing to Prepare for ICD-10 is Preparing to Fail: Part I of III

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The Coming ICD-10 Cash Flow Crisis and How to Avoid It

By Terry C. Kile
Senior Sales Executive, BridgeFront
ICD-10
ICD-10 is the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD). ICD is a diagnosis classification system whose initial version goes back to the Black Plague, when European governments and medical professionals were trying to compare causes of death with those of other nearby countries in order to understand and combat reoccurring disease.

Today, the World Health Organization maintains this comparative information, and since the United States is the only country still using ICD-9, the move to ICD-10 will enable more accurate comparisons of healthcare data with other countries. But the most important part of this change for your practice is that federal regulations will require more and better data tracking to measure the quality and safety of care—something enabled by ICD-10. There are a number of benefits to this transition, says Charles D. Krespan, M.D. of the Drs. May Grant Associates practice.

According to Krespan, “ICD-10 gives us more data about our patients’ medical conditions and the hospitals’ inpatient procedures. Better data leads to better decisions, which leads to better patient care.”

Many prudent hospitals and practices are already preparing for the shift to ICD-10, but most will still make the transition with significant effort and cost.

Frank Musso, of Francis C. Musso, CPA, MPA, P.C., believes the transition will be substantial. “Not only does the new code set include five times as many codes as the ICD-9 code set,” he says, “but the different arrangement of codes will require more documentation, revised forms, retraining of staff and physicians, and changes to software and other information technology. I would also expect changes in reimbursement patterns …. “

“We are very concerned about the ICD-10 transition,” echoes Mona Engle, RN, CEO/Practice Administrator of Drs. May Grant Associates says. Even though she feels confident about the progressiveness and preparedness of her practice, she says “I know that ICD-10 will be very costly in terms of training our staff, implementing the codes and retraining our physicians. It is extremely important that we do it right, because if we don’t it will impact our patients—and that’s something we never want to happen.”

There are only 16 months leading up to the October 1, 2014 deadline. All HIPPA-covered entities must make the change to the new system, or will not be reimbursed by any payer—commercial, Medicare or MA. This would put a severe cramp in your practice cash flow, but can be avoided as long as your practice takes the correct steps to implement ICD-10.
Important note: If making diagnoses prior to October 1, 2014 to be billed or completed (surgical, testing, medication) after October 1, 2014, your deadline for ICD-10 transition is the first time you make that diagnosis. If not, you run the risk of losing the reimbursement or doing all of the medical coding and charting twice for those patient encounters.

Stay tuned for Part II of this ICD-10 blog series coming next week!

Terry C. Kile is a Senior Sales Executive for BridgeFront, an online education provider for healthcare. For information about BridgeFront, go to www.bridgefront.com. Contact them directly by calling 1.866.447.2211.


3 Critical ICD-10 Questions Answered

3 Critical ICD-10 Questions AnsweredBy Kent Lane, COO of BridgeFront

On January 29, 2013 we hosted a webinar with HCPro’s Senior Regulatory Specialist, Jennifer Avery, CCS, CPC-H, CPC, CPC-I. In the webinar, she discussed the key differences between ICD-9 and ICD-10 that could impact a successful migration to ICD-10.

The presentation also highlighted the education needed for your clinical staff, CDIS, billers, and coders to ensure they understand the changes and their role in the conversion – bringing your organization closer to the goal of a smooth transition.

View the recorded presentation in our Archive Webinar Library on our website.

During the questions and answer time at the end of the presentation, there were many questions addressed. Here are the top three questions for all providers and health plans to understand while planning for the ICD-10 transition.

1. We know the AMA is a powerful lobby and has already affected the implementation date once. I understand the AMA is actively pursuing a delay or even cancellation of ICD-10 implementation. Do you think they will be able to affect the date again?

“I hope not, but right now it is out there that AMA is trying to push off implementation by another couple of years – or not implement at all. I hope there are enough of us opposed to this and we can strong arm them right back. We are way behind in our processes and we have out-grown the current system. We cannot ignore the problem.”

2. To what extent do you expect Computer Assisted Coding Systems (CACS) to impact ICD-10 transition?

“Whether good or bad computer-assisted coding will have a major impact on coding and how coders are utilized in the future, especially with ICD-10 transition. The versions of CAC actually make me feel more secure as a coder as I have not found one yet that I think will actually ‘replace’ coders- it will just change how we are utilized. We may actually be doing a lot more ‘clean-up’ after the computer assigns the codes as it cannot replace the coder’s logic.”

3. Before ICD-10, do I need to be certified on ICD-9? If so, what online courses are available?

“I always think it’s a good idea to become ‘certified’ if you are involved in any aspect of coding. If you are proficient in ICD-9 and not currently certified – you may want to go ahead and set for the exam prior to the changes.”

“Then you would be required (depending on organization you get certified through) to either sit for a proficiency exam (AAPC) or get CEUs in ICD-10 (AHIMA). As for the education component to prepare for certification – there are several organizations out there that have various online products and some are dependent on whether you plan to focus on the inpatient, outpatient world, or both. BridgeFront/HCPro alone has several online learning tools to help you prepare for certification.”

“I definitely would encourage you to pick based on reputation and endorsements and not on price, as some promise to give you everything for a small fee – but fall short on content and we have seen a number of students go through other vendors only to be forced to spend additional money with a more reputable training company to gain the knowledge/skills they need.”

BridgeFront has partnered with HCPro to offer a complete ICD-10 and Coding Online Education Program. Learn more at www.bridgefront.com.


Tips on Attending HIMSS13 and Visiting the Exhibition

By Kent Lane, COO of BridgeFronthimss13-logo3

We’re excited to learn about the new Knowledge Centers for 2013 in the exhibit hall at this year’s HIMSS Conference. This is a great opportunity to gain valuable insight into key topics like ICD-10, Mobile Health, and Clinical and Business Analytics/Intelligence.

In each Knowledge Center, there’s a packed schedule of peer-reviewed presentations, case studies, experts to speak with, HIMSS resources, and much more.

If you’re interested in ICD-10, go to the ICD-10 Knowledge Center in booth #4581. Make sure to attend one of the presentations on topics like, “Measuring ICD-10′s Impact on Coder Productivity” on March 4 at 1:15pm and “ICD 10: Bigger Than an IT Issue” on March 5 at 3:30pm.

While there, take a minute to meet the BridgeFront staff nearby in booth #4774. Ask about our newly expanded Coding and ICD-10 Education Program for your staff. Our staff is ready to discuss your organization’s ICD-10 education plan and how we can help.

Here are some tips from HIMSS on visiting the exhibition:

1. “Pre-plan your exhibition experience.”
2. “Don’t miss any of the HIMSS Specialty Pavilions on the show floor.”
3. “Check out Conference Deals and Targeted Exhibitor Listings prior to conference.”
4. “Be ready to network and start developing business relationships.”
5. “Be comfortable. Comfortable walking shoes are a must.”

For more information about BridgeFront’s HIMSS13 booth #4774, read the news here or contact us directly. Call 1.886.447.2211 or email info@bridgefront.com.


The Surprising Link to HIPAA from the ICD-10 Delay

By Peter N. Cizik, CEO of BridgeFront

The dust is finally settling after the masses descended on Las Vegas to attend the annual HIMSS conference in February. ICD-10, meaningful use, and HIPAA were several central themes discussed.

Now last week, the Department of Health and Human Services (HHS) announced a proposed ruling that would extend the ICD-10 compliance deadline until October 1, 2014.

The consensus was that a delay may give some breathing room to organizations that feel they are behind, but would also increase the total cost of the transition. Delaying the pain may feel good now, but it just extends the period of time it takes to “cure” it – sort of like extending your stay in a hospital, which we all know is expensive.

There is an interesting link to HIPAA from the ICD-10 transition. We expect many more service and software providers will be engaged to help organizations figure out the transition – from gap assessments to software tools to help coders and clinicians. This means a big increase in potential business associates, since they will be exposed to protected health information (PHI).

We’ve seen numerous inquiries from business associates looking for independent audits, risk assessments and training as the realities of the potential damage from a breach become more evident. This is a good reminder to re-examine your business associate relationships; have they provided the proof that they are complying with all the regulations?

It’s just good business for both parties; neither wants to deal with the fallout of a poorly handled breach – whether for the impacted patients or to a trusted business relationship.

For more information about BridgeFront’s staff compliance training and risk assessment services, visit our website at www.bridgefront.com or contact us directly. Email info@bridgefront.com or call 866-447-2211.


Why Accurate Clinical Documentation Makes all the Difference

By Lorraine Schnelle, CPA, BridgeFront

As of the date of this post, we still don’t know when we will begin using ICD-10. Regardless, it is imperative that everyone understand how they can influence and support workflow processes within your organization today.

It doesn’t matter if we’re using ICD-9 or ICD-10, detailed and complete clinical documentation is so important. We can all agree the assignment of a diagnosis or procedure code begins with the physician, non-physician provider and other care delivery staff who provide care, as well as documenting the clinical care.

The importance of detailed and complete clinical documentation practices can’t be over-emphasized.

It is essential that current clinical documentation support not only the ICD-9 coding and medical necessity requirements, but also the specificity that ICD-10 will bring. Physicians, non-physician providers and care delivery personnel are vital to maintaining coding accuracy and productivity, but there are others than are also part of the process.

Consider the impact on a hospital’s work processes, accounts receivable, and cash flow if accurate diagnosis codes aren’t obtained at the time of patient intake…what will happen?

1. The health information management (HIM) coders will need to investigate the correct codes—a process that will slow productivity.

2. The claim may be denied because of the incomplete or incorrect code.

3. Patient accounts, finance, reimbursement and/or denial management will need to investigate and take action, resulting in further delays and rework.

So, for those of you that are sitting back and waiting for CMS to confirm the ICD-10 implementation deadline, may I suggest you take time now to review and analyze your patient intake process.

Do this, by identifying specific workflow improvement opportunities to reduce unnecessary rework and denials now. Engage patient access staff in a targeted project to become a safety net, and proactively reduce / eliminate diagnosis code related rework, rejections and denials.

Ready, set, go!


ICD-10: Why Not a Transition Period?

By Lorraine Schnelle, CPA, BridgeFront

I haven’t mentioned 5010 recently as it seems to be the never-ending story. On March 15, 2012, a mere 16 days prior to the re-stated enforcement date of March 31, 2012, the Centers for Medicare and Medicaid Services (CMS) announced another HIPAA 5010 compliance delay in the enforcement of HIPAA 5010 standards until June 30, 2012.

As of the date of this post, I’m beginning to wonder if perhaps the solution to how and when the United States will transition to ICD-10 should be similar to what has occurred with the recent transition to 5010.

I sometimes think it is fun to sit back and think about alternative solutions – even when I know I don’t have all the facts and will never have the opportunity to be in the room to help make the final decision. So, just for fun here’s some commentary.

Right now we are looking at the “big-bang” effect by requiring the usage of ICD-10 diagnosis codes on every health insurance claim submitted by HIPAA-covered entities with a date of service of October 1, 2013 and forward.

So here is my suggestion, allow for a transition period. Under the current ICD-10 implementation requirement, claims with dates of service prior to October 1, 2013 will require ICD-9 codes, thus entities will need to be able support both ICD-9 and ICD-10 codes after the implementation date for a period of time. So, why not restate the compliance requirements?

Allow HIPAA covered entities that are ready to begin submitting and receiving claims with ICD-10 codes on October 1, 2013. While those that are not ready, can continue to submit claims with ICD-9 codes for a defined period of time. Thus, allowing those that are challenged with the current implementation date additional time to prepare and enable those that are able to implement to move forward – a transition period.

Oh, you can shoot a lot of holes in my suggestion. That’s ok, it is only a suggestion and it was fun thinking about it. Do you have a suggestion you would like to share?

Ready, set, go!


ICD-10: How to Maintain Staff Support

By Lorraine Schnelle, CPA, BridgeFront

Almost every day there’s a new article on the reasons for and against the ICD-10 delay, and predictions for when the CMS will make its final decision. So, how do you keep your staff focused on the end goal?

A realistic communication and education plan for ICD-10 is critical to ensuring your organization’s most important asset—its people—is totally engaged and active in supporting the transition to ICD-10.

Three steps to keep people engaged in your ICD-10 plan.

1. Keep talking about the ICD-10 implementation project, and sharing and including others in the work that’s being done. Don’t overlook any coworkers even though their role seems insignificant.

2. Ensure that individual roles and related responsibilities are reviewed to determine how they will affect the transition work that needs to be done.

3. Recognize and give voice to challenges and concerns that arise during implementation; once an issue is acknowledged and understood, you and your coworkers can identify a solution.

How well does your organization focus on training and education? Work towards a “this is very important to our success” attitude.

One of the biggest challenges for an organization may be ensuring everyone receives adequate training on ICD-10. As you know very well, training does take time. Some other valid concerns are:

  • How are we going to complete our daily work when people are attending training?
  • What about the staff members who have to cover for their coworkers who are training?
  • Are you overwhelmed when you’re working short-staffed?

With that said, we’re all being asked to do more with less, and keeping a “can do” attitude is hard to maintain all the time.

Work toward having a “this is very important to our success” attitude rather than “this isn’t my problem” approach as it relates to ICD-10. Also, try and focus on the incremental implementation steps, like training, that will move your practice or organization from here to there.

You can play a major role in minimizing negative outcomes with ICD-10 and instead focus on the steps you can take within your organization to make this transition as smooth as possible.

Looking for more ICD-10 implementation tips and strategies?

Register here for our ICD-10 webinar series with Stroudwater Associates. The next webinar is Tuesday, May 15 at 12:00 p.m. ET.

Ready, set, go!


Don’t Let the Buzz Slow Down Your ICD-10 Plans

By Lorraine Schnelle, CPA, BridgeFront

Lately, it’s been a challenge to keep up with all the “buzz” on the ICD-10 implementation date. There are individuals, organizations, and associations on both sides of the table expressing their opinions on the costs versus benefits of the change.

But, it’s important to keep in mind that it’s “buzz” at this point. As of March 1, there is still no decision on if and when the date will change. So, back to the theme of the day – keep on trucking – and take advantage of the time you have now to prepare for the inevitable.

Putting something off is what many of us do very well. Unfortunately, the date of this change is not like a computer system upgrade cutover date (by the way, your organization controls). In those cases, if specific preparation steps are not completed, you can delay implementation. This is not one of those instances. The federal government will set the ICD-10 conversion date; as of today it is October 1, 2013, and your organization can’t change it. It will occur even if your practice or organization isn’t ready.

Each and every entity that submits and/or processes healthcare claims, reports medical diagnoses to the state, or uses medical diagnoses in claims or other paperwork must use the new ICD-10-CM diagnosis codes. It’s a bit overwhelming isn’t it?

You need to be able to see the big picture; the what, why and when of the transition. However, you also need to go back to basics and focus your attention on breaking down the action steps required to get from here to there and working through each of them systematically.

For example, one of the significant tasks on your practice or organization’s implementation plan will most likely be a form and document review. Whether you’ve implemented an electronic health record or you are using paper forms, each form of media should be reviewed and possibly revised.

Stop and think about all the different forms within your office that have ICD codes associated with them. What forms popped into your mind? Charge slips, templates, encounter forms, superbills, lab requisitions, Advance Beneficiary Notices and more. Okay, that is a bit overwhelming.

But, breaking it down—such as making a list of all the forms and documents that need to be reviewed and revised, as in this case—will help ease the pressure.

We aren’t done talking about this topic so stay tuned for next week’s post when we talk about some more ways to prepare for ICD-10. Ready, set, go!