Sign Up by March 24 to Participate in End-to-End ICD-10 Testing

March 14th, 2014
ICD-10, Preparation, Testing Week

Note: Congress has passed legislation to delay ICD-10 implementation until October 1, 2015. Read the full story here.

In preparation for the October 1, 2014, transition to ICD-10, Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) will conduct end-to-end testing of the new code set during the week of July 21–25. This testing week will ensure that:

  • Providers and claim submitters can successfully submit ICD-10 codes to the Medicare Fee-For-Service (FFS) claim systems.
  • Medicare’s software can properly process claims containing ICD-10 codes.
  • Remittance Advices accurately reflect 2014 payment rates.

CMS will select more than 500 volunteers to participate in its end-to-end testing week. These volunteers will represent a variety of regions and provider, claim, and submitter types, including clearinghouses (which represent many different providers).

If you would like to volunteer to participate in this testing week, you must fill out the volunteer form on your local MAC website by March 24, 2014. After CMS reviews the volunteer applications and selects its final test group, the MACs and CEDI will notify all participants by April 14 and provide them with all the information they need to successfully complete their testing.

In an effort to ensure complete readiness prior to the transition date, CMS will use the data collected during the testing week to address any lingering ICD-10 issues and develop appropriate educational materials.

For more information, check out the MLN Matters fact sheets found here and here.


Survey Says: Providers Lack ICD-10 Readiness

February 24th, 2014
ICD-10, Preparation, Transition

If you’re feeling less-than-ready for the impending transition to ICD-10—set to blast off in T-minus eight months and counting—you’re definitely not alone. In fact, a recent survey by the New York-based healthcare advisory firm KPMG found that nearly three-quarters (73%) of respondents—including health plans, hospital and health system-affiliated providers, large physician groups, and nurses—predicted that ICD-10 would have a moderate to severe impact on their bottom lines. Furthermore, 67% of survey participants admitted that they had yet to conduct end-to-end ICD-10 testing with outside vendors, payers, and software systems.

In this article about the survey, Wayne Cafran, advisory principal in KPMG’s Healthcare & Life Sciences practice, estimates that the organizations in question could suffer financial losses of anywhere from $1 million to $15 million. “Healthcare organizations are in for a rude awakening when they finally realize what [impact] the new standards will have on their bottom lines,” Cafran said.

Following the rules of probability, there’s a solid chance your practice falls into one or both of the groups cited in this study. Which begs the question: If so many players in the healthcare arena aren’t adequately prepared for the switch, how can it go forward? That’s the (literally) million-dollar question many medical providers and organizations are posing as they scramble to adjust their processes to accommodate an entirely new—and much more complex—diagnosis coding system.

In fact, the American Medical Association (AMA) has been very active in building a case for another extension to the ICD-10 deadline. As part of that effort, the group asked physicians to complete a ten-question survey about software readiness. The crux of their argument is that many vendors won’t have their ICD-10 upgrades in place until well into 2014, which doesn’t leave much time for providers to adjust to any changes and work out the kinks. According to the article cited above, the AMA has twice been successful in similar lobbying efforts. But don’t get too excited; as this article explains, the chances of another pushback are slim to none. The fact of the matter is that ICD-10 is coming—whether you like it or not.

So, instead of wasting your time wishing for an extension that’ll probably never happen, you’re better off investing your time and energy into crafting a plan to get your ICD-10 preparations back on track. Need help? Check out the resource page on ICD10forPT.com to download an ICD-10 checklist and a step-by-step guide on preparing your practice for the transition.


Should Your Practice Hire an ICD-10 Coder?

February 17th, 2014
Codes, ICD-10, Preparation, Transition

The switch to ICD-10 will trigger a monumental shift in the way medical practitioners code patient diagnoses. In addition to an entirely new coding structure—ICD-10 codes contain up to seven characters, whereas ICD-9 codes max out at five—ICD-10 incorporates much more advanced anatomical terminology. Furthermore, in addition to coding for patients’ conditions, you often will need to submit supplemental codes to describe how and where certain injuries occurred as well as their degree of severity.

The result is increased specificity in coding, but all that slick, souped-up data comes at a cost—time. And as a rehab therapist, you don’t have a lot of that to spare. So rather than trying to manage the transition—and master a code set with five times more codes than the library you’re used to—all by yourself, you might want to consider calling in some backup in the form of an ICD-10 coder.

Medical coders are trained to review clinical documents and patient records and assign numeric codes for each diagnosis and procedure. So basically, when you have a coder, he or she will take your patient notes and translate them into the correct codes. Those codes help paint a clear picture of a patient’s condition and treatment, thus justifying reimbursement from payers.

Unlike large-scale medical organizations (such as hospitals), most small practices do not have dedicated coders, and with ICD-9—which features only about 13,000 codes to ICD-10’s 68,000—that might work just fine. But beginning October 1, 2015, if your practice fails to record and submit the proper ICD-10 codes, you won’t get paid. That’s a lot of pressure to deal with on your own—and that’s where a pro coder can help. Now, your gut reaction is probably, “There’s no way I can afford to hire a dedicated coder.” But considering the potential revenue loss your practice could suffer if you do not code correctly, the investment might be well worth it.

As this report explains, “The medical coders’ role in assuring that all information is accurate and complete is crucial to the economic well-being of the hospital since their entries determine the amount of reimbursement for patients covered by Medicaid, Medicare and other insurance programs. Coder efficiency in timely processing of coded bills maintains the flow of income into the institution.”

To code effectively, such professionals must demonstrate mastery in specific code sets and the ability to translate specific documentation into codes. For that reason, coders competent in ICD-10 are already in high demand among large institutions that currently retain on-staff medical coders. But as I mentioned above, ICD-10 could prompt smaller clinics to invest in trained coders as well—which in turn would drive up the demand even more. So, if hiring a coder to optimize your clinic’s ICD-10 coding and ensure reimbursements sounds like an attractive option to you, you’ll want to start looking for one sooner rather than later. Remember, you don’t necessarily have to add a full-time, in-house coder to your payroll; if you’d rather outsource to a third-party company (which is typically a much less expensive option), there are plenty of good ones out there. Check out the list at the bottom of this article for some suggestions.

And if bringing a coder on board simply isn’t in the cards—or the budget—for your practice, I would highly recommend sending your clinic’s current coding hat-wearer to an ICD-10 training course or two.

How is your practice planning to handle the switch to ICD-10? Would you consider hiring a medical coder? Share your thoughts in the comment section below.


Medicare’s ICD-10 Testing Week is March 3–7: Want to Participate?

January 30th, 2014
ICD-10, Testing Week

Note: Congress has passed legislation to delay ICD-10 implementation until October 1, 2015. Read the full story here.

The switch to ICD-10 isn’t happening until October 1, 2014, but healthcare industry leaders have tirelessly touted the importance of early preparation. To that end, the Centers for Medicare and Medicaid Services will allow Medicare providers—including physical therapists, occupational therapists, and speech language pathologists—to submit ICD-10 codes in a testing environment during the week of March 3–7.

During the Medicare testing week, you can include ICD-10 codes for fake patients on Medicare claim forms with dates of service ranging from October 1, 2013, to March 3, 2014. This will allow you to see whether your Medicare administrative contractor (MAC) can receive and process such claims. Following the testing week, practitioners who submitted test claims will receive electronic notification of the status of those claims. However, per Common Electric Data Interchange, “testing will not confirm claim payment or produce remittance advice.” We want to emphasize that during testing week, you are to only use fake patients as none of these test claims will receive acceptance or reimbursement.

This is an opportunity for you to assess your ICD-10 readiness in a practice environment. Plus, according to CMS, local MACs will beef up their support resources—including real-time desktop support from at least 9:00 AM to 4:00 PM every day during the testing week—to accommodate the anticipated spike in phone calls.

If you wish to participate, you’ll need to visit your local MAC’s website. From there, look for the ICD-10 icon and click it. That will take you to a blurb about testing week with a link to register. Please note that while WebPT will not release its full-scale ICD-10 functionality prior to the testing week, we will have an ICD-10 testing module available to any Member interested in participating. However, most of our integrated billing services will be conducting testing independently of WebPT, so while all WebPT Members will be able to test in WebPT, they won’t be able to complete the testing process by carrying their test claims through the billing process. For this reason, we recommend that only those WebPT Members who submit their own claims to Medicare or those Members who use the WebPT Billing Service or AdvancedMD participate in Medicare testing week.

As we obtain details from these billing services—as well as further instructions about testing within WebPT—we’ll share them here on ICD10forPT.com, on the WebPT blog, and via email. We’ll also keep you posted about ICD-10 and Medicare developments as well as details regarding the launch of our full ICD-10 solution.

So, to recap, if you want to test ICD-10 codes in your clinic during Medicare testing week:

  1. Determine how you will submit test claims to Medicare (either directly to Medicare independently or through the WebPT Billing Service or AdvancedMD if you’re a customer).
  2. Visit your MAC website, click the ICD-10 icon, and follow their instructions on how to register.
  3. Keep your eyes peeled for an email explaining WebPT’s ICD-10 testing module, which we’ll release later this month.
  4. Check out ICD10forPT.com, peruse the WebPT blog, and sign up for our electronic newsletters to stay on top of all things ICD-10.

ICD-10 and Improved Interoperability in Healthcare

December 16th, 2013
ICD-10, Interoperability

By now, almost everyone in the healthcare industry has heard about ICD-10, the diagnosis coding system that will go into effect October 1, 2015. There’s a lot of information out there regarding this so-called upgrade from ICD-9—some positive, some not-so-positive. According to major healthcare organizations like the Centers for Medicare & Medicaid Services (CMS) and the World Health Organization (WHO), one of the main advantages of making the jump to ICD-10 is that it will significantly improve interoperability. The healthcare industry as a whole, however, is not completely sold on the switch. Some argue that it will not solve interoperability issues, while others suggest that interoperability isn’t even the objective of ICD-10.

The actual impact of the change remains to be seen, but at this point in the game, one thing is clear: the task of improving interoperability rests predominantly with the people directly affected by the transition, including clinicians, billers, and administrators. Curious about the connection between ICD-10 and interoperability? Read on to learn more about the switch and how it could alter the healthcare landscape.

Interoperability in a Nutshell

So, what exactly is interoperability? At the most basic level, interoperability is about information exchange. It occurs when diverse systems and organizations work together for an overarching purpose. In a healthcare context, this means successful, seamless data transmission across all healthcare platforms—a goal that requires both effective communication and adequate technology.

The Role of ICD-10

How would ICD-10 aid in the quest for complete interoperability? Well, for one, ICD-10 code sets are super specific, which means the data they produce will be really specific, too. This system also allows for simplified coding of information, making it easier to share than the more complex code sets of yore. Still, for true interoperability to occur, all of the different systems must be able to “talk” to one another—something that currently isn’t happening on a consistent basis across the healthcare spectrum. Electronic patient record systems are growing increasingly prevalent, but—as Forbes contributor David Shaywitz points out in this article—there are a lot of different electronic medical record systems out there, and they’re not all totally compatible with one another. And in this day and age, it would be nearly impossible to achieve constant interconnectivity and communication across all healthcare providers without across-the-board implementation of secure, portable, cloud-based EMR systems.

It’s Up to You

Positive change won’t happen on its own; to achieve interoperability in the healthcare field, all hands must be on deck. Of course, as with any major transition, there are a lot of naysayers out there—and some of them have valid objections.

In a Healthcare IT News post titled “Will ICD-10 Solve Interoperability Problems?,” author John Lynn makes a fairly strong case against the new coding system improving interoperability, writing, “All we have to do is look at the current ICD-9 diagnosing patterns…often a doctor gets stuck searching for the right ICD-9 code. Right or wrong, they end up picking a code that may not be exactly the right code for what they’ve seen. Maybe they choose NOS (Not Otherwise Specified) instead of the specific diagnosis that would be more appropriate. Add in the complexity of diagnosis requirements for getting the most out of your insurance billing and I don’t think anyone would disagree with the assertion that ICD-9 code entry is far from accurate.” In this article, Lynn also questions how healthcare professionals will possibly be able to master a complex set of ICD-10 codes when they are not even correctly coding in ICD-9.

In the article “Chasing the Tail of Interoperability,” author Gary Palgon urges his readers to recognize that interoperability requires more than just “connectivity”—it requires communication. “Organizations seldom encounter ongoing challenges with connectivity, yet the language—or semantics—used across different disciplines changes frequently,” he writes. Thus, all healthcare professionals must take responsibility for their own data by making sure everyone is on the same page and speaking the same language—at least from a technological standpoint.

Sure, there are a lot of challenges associated with implementing ICD-10, and challenges always breed concerns. But at the end of the day, there’s no sense in complaining about the change. It is going to happen; you can’t control that. What you can control, however, is your attitude and your clinic’s preparedness. Start getting ready now. That way, when the change happens, you’ll not only be less stressed, but you’ll also know that you’re actively helping the US healthcare industry progress toward the ideal of total interoperability.