ICD-10 Preparation Steps and Tips for Medical Providers

As a Provider, ICD-10 preparation, and the subsequent upcoming transition can be a bit daunting. The first thing I recommend you do is to assign one individual to be the driving force behind the process and to oversee the details. This could be your coder, office manager, biller or anyone in your staff with the drive to make it as smooth as possible.

Next, you should begin to develop your timeline. It’s important for you to have goals in place so that you can achieve your plan. One of the key elements you will need to do in your preparation is to identify the most common codes that your practice is using currently. You need to begin to learn what they convert to in ICD-10-CM. The quickest and most effective way to do this is to have a look at your largest bills and review them. You also need to make sure that the coding staff, whether outsourced or in-house, is knowledgeable in physiology, medical terminology and basic anatomy. This is needed to ensure the best possible understanding of the dictation and documentation of the provider.

Examine all your third-party payer contracts. It’s likely you have had a number of services that are provided automatically because of a specific diagnosis or services. You need to look at your contracts and ensure you are using the ICD-10-CM for any services you provide, because unless you know what these new codes are you are not going to be paid.

It is critical to improve your documentation for ICD-10-CM coding. Begin by evaluating your provider’s documentation. Find out where the deficiencies are and where there is a need for education to fill the coding requirements for ICD-10-CM.

Some think that their electronic health record systems will handle all of this, just as many, if not more, are very skeptical. Most auditors, myself included, will tell you that currently most physicians and medical staff are not properly documenting necessary ICD-10-CM coding information.

You need to assess how well your current coding and records system is functioning. For providers, the assessment will include a review of current documentation to evaluate the ICD-10-CM detail that’s required. It should also include mapping the ICD-10-CM and ICD-09-CM codes for the commonly billed codes of the practice and identifying anywhere that there are deficiencies. This will clearly point out what is lacking in order for accurate coding to occur in ICD-10-CM. You may need to hire a consultant, or even temporary staff to complete the assessment and there is often a temporary change to workflow.

Next, you need to start training your staff. The recommended training time is 8 to 16 hours for providers, 4 to 8 hours for IT staff and 24 to 40 hours for coders. You should speak with the software vendor, billing services, clearing houses, payers to ensure all of them are ready for ICD-10-CM, and that you are able to accommodate the new codes.

The final step is to schedule tests and review the results from those tests. You will send simulated transactions and then when you have completed your simulation you will want to review the results and then make adjustments and corrections where needed.

Some payers are already accepting test claims, while others are not ready to do so. Find out when the payer(s) are ready to start testing. It’s important to work out any glitches in advance. You don’t want a delay in your revenue because you didn’t take the time to test right.

View all Articles by: Melissa Clark, CCS-P