The ICD-10 transition is indisputably a daunting challenge, but preparation at the practice level doesn't have to break your budget. That bit of good news highlighted an educational session held Oct. 22 during MGMA-ACMPE's annual conference in San Antonio.[See also: ICD-10 tips for the ICD-tender physician ]
“I would argue (ICD-10 is) probably the biggest change in healthcare since Lyndon Johnson signed Medicare into law in the 60s,” said Robert Tennant, senior policy adviser in MGMA’s government affairs department. “It’s going to impact every system, almost every employee within your practice – maybe not the custodial staff, but just about everybody else.”
The code set itself is not the problem. It’s the massiveness of the code set’s impact.
“This is not just an IT project,” he said. “This is going to permeate every nook and cranny of the practice.”[See also: ICD-10 revenue neutrality: 9 ways to protect your cash flow]
So what should practices do? If you can avoid it, don’t spend any money right now, Tennant said, because there are low-cost things practices can do, at least for a short period of time, to move forward with the transition.
How can practices frugally prepare for ICD-10? Some of Tennant’s suggestions:
- Create an action team. The team should include practice leadership, including clinicians for the purpose of peer-to-peer education.
- Talk about ICD-10 at regular staff meetings so the issue is always top-of-mind. Create a timeline for when things need to be done.
- Assess your internal systems and infrastructure. Figure out how the practice’s software programs will be impacted -- all of them, not just the electronic health record. Will the systems need upgrades? Are upgrades/replacements available from the practice’s vendors? What will it cost to upgrade/replace? Will the practice’s computer hardware be sufficient to handle the software changes or will the hardware need replacing? Will storage capacity need to be increased to accommodate the greater amount of data that will be collected?
- Review your practice’s clinical documentation processes. If they’re lacking, step it up because labeling something “unspecified” may mean the practice won’t get such claims paid. “If you’re a health plan – think about it – you’ve just spent hundreds of millions of dollars upgrading your systems for ICD-10,” said Tennant. “Are you going to accept an unspecified code?” Health plans, including Medicare, Tennant noted, haven’t yet said how payment will be determined.
- Collect and familiarize yourself with the transition tools and resources that are available.
- Consider how the practice’s superbill will be redesigned.
- Determine who needs training -- and at what level -- and when that training should take place. If the practice is paying to train coders, said Tennant, the practice may want to include a clause in coder contracts that says any coder who finds employment elsewhere within a set period following training will have to pay back that training. ICD-10-trained coders will become “instant commodities on the marketplace,” said Tennant. “ICD-10 coders – mark my words – will all be driving Ferraris.”
- Create a budget. No one knows how much the transition will cost, but most estimates, even MGMA’s from 2008, Tennant remarked, are conservative.
- Test with all health plans, not just Medicare.
- Expect that not everyone will be ready by the implementation date in October 2014. Practices may need to set aside cash reserves and get a line of credit, Tennant said. And also be prepared for the likelihood of having to use both ICD-9 and ICD-10 codes for a period of time.
“You may not spend money (right away), but at least understand, and make leadership understand, that this is happening, as far as we know, and we need to prepare for it,” he said.