ICD-10 Readiness Guidelines for Physicians

ICD-10 is being compared to the “Y2K” of the Healthcare industry. With that in mind, it is critical that physician practices be prepared for ICD-10 coding to minimize revenue flow disruption and ensure clinical documentation matches ICD-10 specificity.

According to an April 2013 survey of 500 physician practices conducted by Navicure, practices consider physician/staff training and payer readiness to be the two biggest challenges concerning the ICD-10 transition. One third of practices surveyed anticipate a productivity drop between 20 and 40% in the 4th quarter of 2014 (the initial 3 month period of ICD-10 coding).

Navicure recommends the following 7 steps to prepare for ICD-10 coding:

1)       Build an ICD-10 team internally (in a small practice, this could be every staff member)

2)       Review clinical documentation to ensure it supports ICD-10 granularity.

3)       Conduct a gap analysis to map your most commonly used ICD-9 codes to ICD-10 codes.

4)       Update your technology (EMR,PMS,Clearinghouse solutions) to support ICD-10.

5)       Provide internal support (budget for training, testing, etc.).

6)       Provide targeted ICD-10 education to physicians, coders/billers, and clinical staff.

7)       Test and monitor ICD-10 coding several months prior to Oct 1, 2014 to validate the efficiency of ICD-10 charge capture and the accuracy of the ICD-10 codes selected by your practice.

Historically, there has been a lack of payer preparedness with previous industry transitions, such as the transition from 4010 to 5010 electronic claims transactions. Larger payers (Medicare, BCBS, Aetna, UnitedHealthCare, etc.) are more likely to be ready for ICD-10 than smaller payers. MTBC recommends working closely with your billing vendor and/or clearinghouse to verify when payers will be ready to test ICD-10 codes and if payers will be ready to accept “live” ICD-10 codes on October 1, 2014.

MTBC will work very closely with its clients to test ICD-10 claims with payers and ensure minimal cash flow disruption related to ICD-10 payer and clearinghouse denials. MTBC is committed to identify and fix any client concerns that arise during ICD-10 testing to ensure a smooth ICD-10 transition.

The key to success for physicians practice regarding the ICD-10 transition will be:

1)       Developing an Internal ICD-10 transition project plan

2)       Comprehensive training for providers and affected staff

3)       Coordinating testing and implementation with your vendors, clearinghouse, and payers