Is Your Axe Sharp?

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“If I were given eight hours to chop down a tree, I would use six hours to sharpen my axe.”  – Abraham Lincoln

Beginning Oct. 1, 2013, everyone who is covered by the Health Insurance Portability and Accountability Act (HIPAA) must transition from ICD-9 to ICD-10. Practices need to be preparing now to avoid potential reimbursement issues.

Some major differences between ICD-9 and ICD-10:
• The overall number of codes has significantly changed: There are about 14,000 ICD-9 codes. There are approximately 70,000 ICD-10 codes.
• ICD-10 has alphanumeric categories rather than numeric categories.
• The organization and structure of the codes have been changed.
• Clinical conditions have been regrouped.
• Codes have greater specificity with ICD-10 and are up to seven characters long vs. the five of ICD-9.
• ICD-10 codes may include an “x” placeholder— something not used in ICD-9 codes.

Some benefits of ICD-10:
• More easily conduct research, epidemiological studies and clinical trials.
• More closely monitor resource utilization.
• Improve clinical, financial, and administrative performance.
• Better track public health and risks.
• Reduce the need for attachments to explain a patient’s status.
• Improve payment systems and process claims for reimbursement.
• More effectively set health care policies.

Did you catch that? Health care policy and reimbursement are going to be more influenced by a patient’s overall condition, treatment plans and outcomes than ever before. Providers aren’t accustomed to reimbursement based on diagnosis; however, it seems ICD-10 promises to bring about change to reimbursement methodologies. Not sure exactly what that will look like, but changes are certainly on the way.

Prepare for ICD-10:
• Start now by contacting your vendors (for items such as billing software, electronic health record system and clearinghouse services) to see what progress they have made toward the changes and what plans they have in place to comply with the timeline.
• Appoint someone in the practice to be responsible for keeping up to date with the compliance timeline, training of physicians and staff, and evaluating the overall impact of ICD-10.
– This may be one person for a small practice or a team for a larger practice.
– If no one is available within your staff, invest in a consultant educated in ICD-10 implementation and guidelines.
– Set up a budget for costs pertaining to training and education as well as potential software and hardware upgrades or changes.
• Begin asking payors how they are managing the transition to ICD-10 and whether they anticipate any changes to existing medical policies. There will be obvious changes to “payable” diagnosis codes for medical policies. Because there’s no direct crosswalk from ICD-9 to ICD-10, you’ll need to review all Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs) and each payor’s medical policies pertaining to services routinely rendered by your practice.
• Be prepared to evaluate and make changes to current operations to make ICD-10 transition successful.

Your practice should also be prepared for the implementation of the 5010 protocol for submitting electronic claims. On January 1, 2012, standards for electronic health care transactions change from Version 4010/4010A1 to Version 5010. This is an integral part and an important step to the process of the ICD-10 implementation. The 5010 protocol will allow for the new longer alphanumeric diagnosis codes. Electronic claims submitted to Medicare on or after January 1, 2012, must use the new protocol or they won’t be accepted.

As with any transition, preparation is the key. So the question remains, Is Your Axe Sharp?

—Marty Hudson

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