Updated on: November 21, 2016

ICD-10: Last-Minute Tips for Maximizing Your Remaining Time

By Ken Bradley
Original story posted on: September 23, 2015

While the term “countdown” has debatable origins, scholars have attributed it to events as different as space shuttle launches, New Year's celebrations and Cambridge University rowing races, most healthcare insiders agree it now applies to ICD-10.

Although many providers have counted down the time remaining until the ICD-10 transition, we can now tick away the remaining days on one hand. After months and years of monitoring deadline changes, listening to industry debates and implementing rigorous transition plans, everyone is likely nervous and relieved about Oct. 1.

Providers’ level of preparedness, however, differs widely. Another difference among providers? Their reactions to the Centers for Medicare and Medicaid Services’ (CMS) July announcement regarding the ICD-10 transition.

Flexibility rather than reprieve

Just as providers rose to a new level this summer, CMS announced it will afford providers more flexibility as they adjust to ICD-10. Even though there is no reprieve of the implementation date, CMS’ allowance does help providers by giving them an adjustment period. First, CMS established an ombudsman’s office to triage and answer ICD-10 claims submissions questions. Second, with the exception of services covered under a medical necessity policy, providers can use less specific ICD-10 codes for awhile as their teams become accustomed to new requirements related to the new code set’s breadth and specificity.

While many providers breathed a collective sigh of relief when CMS made its announcement, it’s important to recognize it for what it is: flexibility in using the code set rather than a reprieve regarding the transition date. Also, the CMS announcement only applies to its claims and excludes anything submitted to commercial payers; therefore, providers will be better served if they forge ahead at full speed with their transition plan which, includes as much as possible, use of the most specific ICD-10 value available. During this final countdown, providers can make a final assessment regarding their ICD-10 readiness, adjust their plan accordingly, and encourage their teams to maintain intense focus for the final countdown days and time immediately following the transition.

All practices must make sure at this late date that the essentials are in place to accurately assign and report ICD-10 values beginning Oct. 1, 2015. Practices should ensure their clinical documentation contains the necessary specificity to support ICD-10, that coders have knowledge of ICD-10 for accurate application of the new code set and that all IT and paper based systems have been updated to accommodate the new code set.  Practices may also want to include as part of the essential preparation obtaining a line of credit to draw against should there be a downturn in revenue.

Devising a countdown action plan for any level of readiness

  1. The Very Ready - Providers that created a comprehensive ICD-10 plan and stuck with it, despite delays and competing priorities, are in an enviable position. Take a moment to thank and congratulate your team! If you’re in this fortunate group, you can further maximize preparedness by reviewing and analyzing current workflows and processes to ensure that they are automated as much as possible, along with including new tools, such as electronic code books, to improve efficiencies. Consider a final review of your entire ICD-10 process, from clinical documentation through coding and claims submission. Use claims management and receivables analytics to identify trends and better understand where you may have hiccups and bottlenecks on October 1.

  2. The Partially Ready - In Navicure’s August 2015 survey of healthcare organization leaders, only 43 percent of respondents felt they were on track with ICD-10 preparation efforts; therefore, most providers are likely in the “somewhat but not 100 percent ready” category. Practices that have implementation steps "in-flight" or stopped because of the multiple industry delays, need to first assess what has been done and has not been done, prioritize to ensure that the essential steps are completed first and test internal changes to make sure that they are ready for use on Oct. 1, 2015.

  3. The Really Not Ready - If you feel quite unprepared, you’re not alone. With competing priorities and slim resources, many providers feel they are not close to being ready for the transition. You can gain focus by identifying your organization’s most critical codes, for example, the top 10 most frequently used and the highest revenue generators. Creating an intensive action plan that ensures the essentials are in place is a critical next step. After identifying what needs to be done, rally your entire team in understanding that codes are most important and in making the necessary workflow and system changes to ensure readiness for Oct. 1. Focusing on the your practices most used codes and a plan that ensures the essentials are in place in time can give your team a boost of confidence and the direction it needs, whether you have a team of two or twenty. 

Achieving last-minute peace of mind

With external factors such as payer readiness, no provider can truly anticipate what will happen in October, regardless of their ICD-10 readiness efforts. Providers can create a financial safety net by talking to their bank or filling out paperwork for a line of credit. In the best-case scenario, the extra cash on hand won’t be necessary; however, it can provide peace of mind during an unpredictable time.

As you determine how to best use your remaining time, remember the value of accuracy over speed. Accurate and comprehensive clinical documentation and coding is the foundation for every clinical and financial step changed by ICD-10. The specificity of patient data for coordinated care, breadth of data for public health research and timely claims payment all begin with your physicians’ clinical documentation. Achieving this accuracy will stand your organization in good stead, even if you initially have slower documentation, coding and claims payment. Work with your physician, coding and revenue cycle teams to make sure they have all the information they need to attain accuracy, and understand that speed may have to wait. Even though it’s tempting to push for speed while avoiding answering whether or not we are documenting and coding correctly can lead to longer-term significant problems. 

It’s also important to revisit how your clearinghouse has prepared for the post-transition timeframe. How will they handle the abnormally high rejection rates? What is their strategy for communicating and addressing payer issues as they arise? Having peace of mind regarding your clearinghouse’s readiness can give your team more confidence as Oct. 1 draws closer.

Generally speaking, countdowns refer to exciting and much-anticipated events. ICD-10 should be perceived that way, too. Although tensions are high and everyone’s workloads are even higher, the new code set will enable great clinical and financial improvements. The initial transition period may be difficult, but providers and patients will ultimately benefit.

Keeping the focus positive and ICD-10’s value front and center can help provider teams push through these final countdown days and into a successful October.

About the Author

Ken Bradley, vice president of strategic planning and regulatory compliance and one of Navicure's founding members, is responsible for assessing markets, monitoring government regulatory requirements and providing competitive analyses to develop strategies and solutions that ensure Navicure and its clients continued success in an increasingly complicated business environment.

He is responsible for all Navicure industry transitions, including ICD-10 and 5010. He has given educational presentations and written several articles on 5010 and ICD-10.

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