By William Brady, May 01, 2014
As of Oct. 1, 2015, you will be required to start using the ICD-10 code set. (Congress delayed the Oct. 1, 2014 deadline as part of legislation to patch the Medicare payment formula that passed at the end of March.) This means that on Oct. 1, 2015, you will need to start reporting patient diagnoses as well as submitting claims using this new coding standard. Physician practices, hospitals, Medicare, Medicaid, private payers, and clearinghouses will need to start using this new code set by this critical date. Failure to do so will result in significant financial disruption, as claims filed using ICD-9 after Oct. 1, 2015 will be denied.
What does this mean for a dermatology practice?
The time to develop an action plan is now — and for practices that file their claims electronically, working closely with the practice’s various business partners will be crucial. Coordination with software vendors, clearinghouses, payers, and outside billers (if applicable) will be necessary to make a successful transition to ICD-10.
The first step is to work with your software vendor(s) to determine the timing and cost of upgrades necessary for ICD-10. Does your contract with your EHR or practice management system vendor cover the upgrade or will there be additional costs? There’s no getting around or delaying upgrades that are required to submit ICD-10 compliant claims, but if you’ve been thinking about making a change anyway an expensive upgrade may be what makes you pull the trigger.
Whether you stick with your current vendor or switch, find out when your systems will be ICD-10 compliant. You’ll need to allow time for staff training once the software upgrade or installation is complete — at least a few days for everyone to become familiar with how the new system works, preferably longer if you have time.
Once your staff members are trained, test and verify that ICD-10-compliant claims can be transmitted successfully to the practice’s clearinghouse and payers without technical difficulties and delays. Failure to test in advance from end to end to determine readiness may risk disruption in cash flow. [pagebreak]
All of this sounds simple enough, but you also have to make sure that your business partners will be ready on Oct. 1, 2015. To better understand what this means for you and your practice, think of the administrative processes and transactional steps involved with writing a check: You fill in the amount and sign it and as far as you’re concerned, the money is as good as gone; the person who receives the check — let’s say the owner of your cleaning service — signs the back and deposits it and the transaction is complete. But a lot of other steps take place behind the scenes to ensure that the money that started out in your account, with one bank, ends up in the account of your cleaning service, with another bank. The process of submitting a claim for payment and having it paid is similar, and a failure in one of the steps will prevent you from being paid.
So, you should develop a plan to monitor the full ICD-10 compliance progress of your business partners, including your clearinghouse, Medicare contractors, state Medicaid agency, and private payers. In the case of payers this may be as simple as visiting their respective websites or watching out for emails from them to ensure that they will be ready. With partners like your clearinghouse and/or outside billing service, you’ll want to have direct communication to discuss requirements, changes, timing, testing, and the impact of ICD-10 on the processing of your claims.
If you don’t see progress from any of the above entities, contact them directly by phone. When checking in with payers, don’t forget to find out when their claims and payment edits will be released. Basically, these edits are technical tweaks used in processing, validating and paying claims, and range from standard to more particular data programming edits needed to support either all or specific payer payment requirements. If you bill electronically, your clearinghouse may have advance information regarding claims processing and payment edits, so you can also request this information from your clearinghouse if necessary, and plan ahead accordingly.
Ready to get started? For more ICD-10 help from the AAD, visit www.aad.org/ICD10.