Get Ready for Industry Wide Impact of ICD-10

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Get ready for the widespread organizational change that will occur for healthcare providers and payors by ICD-10 conversion with this guide from McKesson Practice Consulting.


  • 1. Get Ready for Industry-Wide Impact of ICD-10By Bess Ann Bredemeyer, BSN, RN, CHC, CPC, PCSDirector of Compliance ConsultingPreparing for Widespread care by indicating more precisely the detail in clinical documentation that willOrganizational Change diagnosis, and will better match the identify and support the diagnosis or payment for care to the care delivered. procedure.While some hospitals, practices and In time, it will promote greatervendors are focused exclusively on the efficiencies in care documentation and The specificity and expanded dataheavy lift of qualifying for stimulus claims processing. will enable improved analysis of carefunds and achieving meaningful use, delivery for quality and regulatoryfoundational regulatory change is on In some cases, providers will receive reporting. Increased detail for analysisits way. The change to an expanded more appropriate reimbursement for also can be leveraged for processcode set for diagnoses and procedures, complex procedures that couldnt be improvement and pay for performance.ICD-10-CM and ICD-10-PCS, will bring differentiated with the previous ICD-9sweeping changes to the processes code set. What used to be one code The Centers for Medicare & Medicaidand IT solutions used by providers and in ICD-9 may be multiple or even Services (CMS) reports that codingpayers, clearinghouses and software many codes in ICD-10 that provide professionals are advising organizationsvendors. The Oct.1, 2013 mandate greater clinical specificity and can to begin training six months prior to thewill affect all aspects of a providers better indicate levels of complexity. For compliance date. The American Healthoperations since the provision of care, example, the codes differentiate body Information Management Associationalong with the appropriate diagnosis parts, surgical approaches and devices (AHIMA) suggests starting three to sixand procedure codes, drive the delivery used. months prior to the date.and business of healthcare. There should be fewer requests for All Care StakeholdersBenefits from the Change to more procedure information to validate Will Be Affectedan ICD-10 Code Set reimbursement because of the greater specificity of the code set. However, The ICD-10 code set will have far-Already in use by other developed knowledge and application of the reaching impact on inpatient andcountries around the world, the code correct code becomes even more ambulatory provider processes andsets are expanding from an approximate critical. Protecting reimbursement will departments admissions, eligibilitytotal of 20,000 to more than 155,000 require extensive training not only of checking, medical necessity, contracting, almost an eight-fold increase. The coders, but also of physicians and other care delivery, ancillary services, billing,expansion may benefit the delivery of code users, who must provide the claims, super bills, encounter forms
  • 2. and quality reporting. Payor processes healthcare data. CMS is requiring an 4. Create a project plan detailingwill be affected extensively, including update of the 4010/4010A transactions essential components for success:medical policy, contracts and claims to the new ANSI X.12 Version 5010, Key components would includeadjudication. All stakeholders must which among other things will support communications, training and aprepare to transmit transactions using the ICD-10 codes. ANSI 5010 must be software roadmap.the new 5010 format. in use by Jan. 1, 2012. 5. Identify clinical documentationThe health IT systems that support See the 10 Steps for Providers to Get required for coding: Reinforce thethe care stakeholders and processes Ready for ICD-10 below for a high level requirements in your organizationswill be affected wherever there is a checklist to assess your readiness. policies and procedures.diagnosis or procedure code entered, 6. Schedule and implementprocessed or transacted (visible or 10 Steps to Prepare for ICD-10 updated IT solutions: Ensureinvisible), changes must be made. your implementation schedule These 10 steps will help you get ready provides time to perform any systemBecause of the magnitude of the for the transition to the ICD-10 code sets. You may want to forward this upgrades, test releases and installdifference in the number of codes to those in your organization who are updates. Determine when and howin the sets, many times there will be working on this initiative. long you need dual coding crosswalks with a one-to-onematch. Software mapping tools will 7. Train coders on new code sets:provide an equivalency of one-to- 1. Establish governance and Review coder experience theone, one-to-many, many-to-one, etc. responsibility: Identify a project new code set will require increasedThe government is providing General manager. For larger groups and familiarity with medical procedures,Equivalency Mappings to help in the hospitals set up a multidisciplinary anatomy and pharmacology.development of these tools. team and governance steering committee. Communicate the 8. Train physicians on new financial ramifications of not being documentation requirements:The Timeline for Change ready to gain buy-in and funding Start Yesterday Educate physicians on areas from the executive team. that require increased clinicalWhats the timeline? The date for use of documentation. 2. Launch your ICD-10 compliancethe new code set is any service date or initiative: Hold your kick-offdischarge date on or after Oct.1, 2013. 9. Perform service line assessments meeting and communicate timelines and potential impact to cashAnd contrary to the hope and belief of and impacts of the change to allmany healthcare organizations, CMS flow: Review coding that supports staff. Ensure coders, physicians and your key service lines and mostdoesnt appear to be backing off from other billing staff understand thethat date. Because some encounters commonly assigned and highly impact on reimbursement and days reimbursed DRGs.will still be in process for previous in accounts receivable for claimsservice dates, it is anticipated that both that are not properly coded or 10. Use enterprise intelligenceprovider and payer systems will need substantiated. analytical tools and reportingto support both the ICD-9 and ICD-10 to monitor compliance andcode sets for a period of time. 3. Conduct a readiness assessment: financial performance: Check Assess the impact to policies and first-time submission claims successCMS is laying the foundation for the procedures, payor contracts, training rate, reimbursement turnaroundchange by requiring an update of needs, staff augmentation or time, days in AR, source of claimsystems that support the electronic outsourcing and determine software edits, source of denials and staffdistribution of information (EDI) of vendor readiness. compliance/productivity.
  • 3. Start Now. While the date to comply About the Authormay seem far in the future, dontunderestimate the amount and Bess Ann Bredemeyer, BSN, RN,complexity of change that will be CHC, CPC, PCSrequired. While many organizations are Director of Compliance Consultinghoping for a reprieve from the Oct. 1, McKesson Practice Consulting Solutions2013 compliance date, CMS is holdingfirm at this time, saying there will be no Responsible for McKessons consultingdelay. services related to physician practice coding and compliance, BredemeyerIf you need assistance in getting has more than 27 years of experience inready for ICD-10, McKesson Practice assisting physicians, office, and billingConsulting Solutions offers services staff with their coding and compliancesuch as readiness assessment, roadmap needs. Prior to joining McKesson,development and implementation. Bredemeyer was the compliance andFor more information, please email privacy officer for a large or call health center and was an active1-800-789-6409. practicing critical care nurse. She guest lectures at physician forums and residency programs, and has authored several articles relating to physician coding and compliance.McKesson Provider Technologies5995 Windward ParkwayAlpharetta, GA 2011 McKesson Corporation and/or one of its subsidiaries. All rights reserved. All product or company namesmay be trademarks, service marks or registered trademarks of their respective companies.REV-629 02/2011