ICD-10 from the Patient’s Perspective

August 19th, 2015
ICD-10, Patient care, Transition

We know you’re working hard to get your clinic ready for ICD-10. From the front office to the back, every person in your practice is gearing up for October 1, 2015—except for your patients. But that’s not a bad thing. In fact, in most cases, your patients don’t even need to know about ICD-10. Have you ever explained ICD-9 codes to a patient? Probably not—and your patients have likely never asked about them, either. So why would that change along with the healthcare industry’s code set?

Hint: It wouldn’t.

Patients won’t suddenly develop the urge to learn about medical billing just because you’re switching to ICD-10. The majority of your patients are much more concerned with getting better than they are about the codes you’re using to bill their insurances. Besides, informing patients of ICD-10’s demand for greater documentation specificity might cause them to unnecessarily question your pre-ICD-10 documentation practices.

Ultimately, when it comes to switching code sets, what your patients don’t know won’t hurt them—unless you expect your clinic’s productivity to take a deep dive, especially with respect to the speed of patient intake. Even in that situation, you don’t need to spend 30 minutes explaining (or complaining about) the transition to ICD-10. Instead, simply tell patients that, due to new government regulations, your staff must complete additional paperwork, which has caused some temporary front office delays. Any patient who’s had to file taxes will cut you some slack.

Luckily, you’ve got one less thing to worry about when it comes to preparing your practice for ICD-10. To put all of your coding concerns to rest, don’t miss our upcoming ICD-10 Bootcamp webinar on August 31, 2015. Register here to save your spot.  

3 Costly ICD-10 Pitfalls and How to Avoid Them

August 11th, 2015
ICD-10, Preparation

The switch to ICD-10 doesn’t have to be crazy-expensive, but if you make a couple of big missteps, your whole practice could take a financial tumble. Like navigating a magical hedge maze to retrieve the Triwizard Cup, making the transition to ICD-10 could be full of costly pitfalls. Here are three common ways ICD-10 can empty your bank account—and how to avoid them:

1. Weak Cash Flow

During the transition to ICD-10, it’s possible you may experience a delay in payments due to coding errors and vendor or payer under-preparedness. That’s why you need to do everything in your power to make sure your revenue stream keeps flowing. To that end, you should first assess your current billing workflow to determine how quickly and cleanly your practice currently processes and receives payment for claims using ICD-9 codes. This will allow you to correct any kinks in your workflow and give you a much better sense of how ICD-10 could affect your cash flow after the transition. Depending on the results of your assessment, you may need to consider hiring coders, better training your front office staff on billing, or working with an automated billing service or software.

2. Poor Productivity

While we can expect a certain degree of diminished productivity during the transition, it shouldn’t be severe—or permanent. To keep your clinic running at top speed, start by determining your practice’s most commonly used diagnosis codes and their most specific ICD-10 equivalents. That way, your staff can spend more time billing and less time searching for codes. While you’re at it, a recent Medscape article recommends that you start phasing out unspecified diagnosis codes. Not only can unspecified codes give way to questions that bog down your billers, but they also can cause ICD-10 claim denials.

Another way to prevent productivity loss is to ensure your billing, practice management, and EMR vendors—and payers—are ready for ICD-10. First, find out which of your vendors and payers will be affected by ICD-10. Then, you’ll need to:

  • Determine their testing processes and schedules.
  • Submit and review test data.
  • Update your billing process—and perhaps your vendors—based on the results of your testing.

For more details on external testing, check out our blog post here.

3. Lack of Training

Just as investing in Apple stock when it first went public in 1980 was a good idea, so is training your staff on ICD-10 now—before it becomes a big to-do. Otherwise, you’re in for a rough transition—complete with heaps of staff frustration. Switching to ICD-10 isn’t exactly a small change. The new code set has 55,000 more codes than ICD-9. To further complicate matters, while ICD-9 codes are mostly numeric and have just three to five digits, ICD-10 codes are alphanumeric and contain three to seven characters. So, while some folks will feel the impact more than others, all of your staff members should go through some kind of ICD-10 training to ensure everyone is on board with the change and understands the new coding requirements.

Be patient and flexible with your staff while they learn the new structure, but make sure you develop—and stick to—a training timeline and strategy. To vary your educational style and keep costs down, take advantage of free educational tools, like ICD-10 for PT and the WebPT Blog. We’ve got tons of articles, webinars, handouts, checklists, quizzes, and games to help prepare your staff for the switch.


Knowing three of the most common ICD-10 pitfalls for PTs—and how to arm yourself against them—will help you avoid a financial fiasco come October 1. But that doesn’t mean the transition will be totally easy. Make sure you download The Physical Therapist’s Crunch-Time Guide to ICD-10, and don’t miss WebPT’s upcoming webinar—ICD-10 Bootcamp: Coding Exercises for PTs and OTs—on August 31, 2015, at 9:00 AM PDT / 12:00 PM EDT.

The Penny-Pincher’s ICD-10 Plan

July 24th, 2015
ICD-10, ICD-9, Preparation, Transition

With only about two months to go until the mandatory switch to ICD-10, your clinic should be fully entrenched in its preparations. If you started early, you’re probably feeling pretty good about where you’re at. Maybe you even feel totally ready to tackle the change. But if you didn’t start early—or if you haven’t started at all—you’re likely feeling the pressure on your practice and your bottom line. If your clinic’s staff doesn’t understand how to correctly code using ICD-10, you’ll suffer the financial consequences. Luckily, the Centers for Medicare and Medicaid Services (CMS) have granted providers with a one-year grace period—which could save you some delayed payments and claim denials due to ICD-10 coding errors. But the cost of transitioning to ICD-10 begins well before we actually switch code sets.

To help cover the cost of preparation, you could consider securing a line of credit with your bank or having three to six-months’ worth of cash on hand to keep your clinic afloat. But if those options aren’t available to you—or if you’d rather keep your purse strings tied up—you’ll need a penny-pinching preparation plan. Here are seven tips to help you prepare for the switch to ICD-10 without breaking the bank:

  1. Clear out your current reimbursement backlog and collections accounts to beef up your cash reserves.
  2. Take advantage of free educational tools, like ICD-10 for PT and the WebPT Blog, to educate you and your staff. Training is necessary, but it doesn’t have to be expensive.
  3. Determine your practice’s most commonly used diagnosis codes—and their most specific ICD-10 equivalents—to soften the blow to your productivity come October 1.
  4. Test with your payers and vendors. Testing externally is free and verifies that all of your software and outsourced services are ready to receive, process, and remit for ICD-10 codes. If they aren’t ready, you might have to consider working with new vendors. That might not be in your budget, but unprepared vendors will cost you more in the long run.
  5. Asses your current billing workflow. Determine how quickly and cleanly your practice currently processes and receives payment for claims using ICD-9 codes. This will allow you to correct any kinks in your workflow, and you’ll have a much better sense of how ICD-10 affects your cash flow after the transition.
  6. Test internally. Ensuring your team efficiently and appropriately assigns ICD-10 codes doesn’t cost you much more than time right now, and it will save you a lot of money later.
  7. Create a retention plan. If any of your staff are already trained on ICD-10, they’re a valuable commodity. Do what you can to keep these employees—and their knowledge—at your practice.

Ready or not, we’ll have to transition to ICD-10 on October 1 (barring any unlikely Congressional delays). Fortunately, it doesn’t have to cost an arm and a leg to prepare your practice. With these seven tips in mind, you can get your clinic up to speed—and keep your savings intact.

AMA Asks CMS for ICD-10 Grace Period

June 23rd, 2015

Even though we have under four months until the October 1, 2015, deadline to transition to ICD-10, the American Medical Association (AMA)—which has long opposed the switch—is still doing its best to put the kibosh on our nation’s transition to the nearly-outdated coding set almost everyone else has already adopted. But instead of shouting from a soapbox, the AMA is now scrambling for safe harbor.

Despite having years to prepare for ICD-10, the AMA claims that “ICD-10 will significantly overwhelm physician practices with a 400 percent increase in the number of codes physicians must use for diagnosis.” Therefore, the association believes clinics need more time to learn how to properly bill using the new code set. According to the AMA Wire, at this year’s Annual AMA Meeting, the organization passed a new policy, which asks the Centers for Medicare & Medicaid Services (CMS) to not “withhold claim payments based on coding errors, mistakes or malfunctions in the system” for two years after implementation—a move the AMA believes will help prevent disruptions in cash flow.

While maintaining cash flow during the transition is a good thing, it’s only a temporary solution to a long-term problem. It’s too soon to tell if CMS will agree to the AMA’s request, but even if it does, giving folks more time to get up-to-speed may result in some clinics further procrastinating in their preparation efforts. A lack of claim payment penalties doesn’t mean you can stop or delay educating yourself or your staff on how to code using ICD-10. The real safe harbor is knowing your clinic is ready to bill—and get paid—once the transition comes. Take advantage of the resources we make available on this website to ensure you’re ready.

ICD-11: WHO’s With Me

May 11th, 2015

As the United States prepares for the transition to ICD-10 on October 1, 2015, the rest of the world—most of which boarded the ICD-10 coding train long ago—is turning its focus to ICD-11. With implementation set for 2017, the World Health Organization (WHO) is hard at work refining and improving the International Classification of Diseases (ICD) coding set “to better reflect progress in health sciences and medical practice.”

So, what does that all that mean? Here’s the deal.

What to Expect

The latest ICD update will be:

  • Available in multiple languages.
  • Defined in a structured way, so medical professionals can more accurately record definitions, signs and symptoms, and other disease-related content.
  • Compatible with electronic health applications and information systems.
  • Free to download online for personal use (and available in print form for a fee).

Get Involved

Want to take part in the revision process? You’re in luck. To “increase consistency, comparability and utility of the classification,” the WHO has invited experts and stakeholders—including researchers, health information managers, and healthcare providers—to participate in the review. You can become an appointed reviewer, or you can create an account on the ICD-11 online platform, which will allow you to:

  • Comment on classification structure, content, and implementation
  • Propose changes to ICD categories or disease definitions
  • Participate in field testing
  • Contribute to language translations

Keep in mind that all feedback will be peer-reviewed for accuracy and relevance by experts from the WHO’s two advisory bodies: Revision Steering Groups and Topic Advisory Groups.

While the US might not be ready for ICD-11—I mean, we’re still bracing for ol’ 10—it’s in our best interest to participate in—and keep one eye on—the revision process. It’ll undoubtedly help us when it comes time to transition again.

ICD-10 Delay Still Possible? All Signs Point to Definitely Not, Maybe

April 29th, 2015
ICD-10, ICD-10 Delay

The tumultuous road to ICD-10 has been fraught with anxiety, dissenting voices, and delays. Furthermore, uncertainty over the possibility of further setbacks has led many providers and vendors to fall behind in preparedness. However, as you may already know, ICD-10 didn’t make it into the newly passed SRG bill (a.k.a. HR2). And that’s a positive step forward from last year’s SGR legislation, which ultimately delayed implementation until October 1, 2015. But does that mean we’re really free and clear of yet another delay? Eh—sort of.

Even though this year’s legislation didn’t mention ICD-10, it could have. If Rep. Gary Palmer (R-AL) had been successful, HR2 would have included an amendment postponing the ICD-10 transition until October 1, 2017. Thankfully, that proposal didn’t make the cut, but the fact that it was part of the conversation at all is a bit worrisome. Plus, there are still folks out there—like Sen. Rand Paul (R-KY), Sen. John Barasso (R-WY), Sen. John Boozman (R-AR), and Rep. Ted Poe (R-TX)—who could attempt to resurrect dead amendments or push brand new legislation through to enactment as quickly as last year’s Protecting Access to Medicare Act.

The good news is that folks seem to be on board the ICD-10 train in much greater numbers than last year—and the dissenters have been far less vocal with their concerns. And ultimately, the government has made zero effort to further push back the deadline for the switch to ICD-10, and officials seem confident that CMS is ready for the transition. Members of the House Energy and Commerce Committee’s Subcommittee on Health have even declared their support for maintaining the current deadline.

While another delay is unlikely, no one can predict the future. Still, one thing remains certain: practices must be prepared. Stick to your ICD-10 preparations schedule, and keep an eye out for updates. If things change, we’ll let you know.

The Survey Results Are In (And I Don’t Think You’re WEDI for This Jelly)

April 22nd, 2015

We’re flying toward the ICD-10 implementation on October 1, 2015, but uncertainty regarding future delays—not to mention budgetary, staffing, and technological challenges—have caused vendors and providers to pull up on their ICD-10 preparations. According to the most recent Workgroup for Electronic Data Interchange (WEDI) survey, vendors haven’t made any progress in their preparations in the time since they participated in previous surveys. And providers? They’re actually falling behind in ICD-10 readiness.

Shockingly, a full two-thirds of the 796 providers surveyed have slowed or stopped preparation efforts, and only about 33% of providers have completed their ICD-10 risk assessments. To make matters worse, more than 25% of providers indicated that they didn’t plan to test externally until the second or third quarter of this year, and only 25% have tested with Medicare at all.

The grass on the vendor side isn’t much greener. Of the 173 vendors surveyed, only 60% are currently testing or ready for ICD-10—down 7% compared to the results of WEDI’s August 2014 survey. And just like the providers WEDI surveyed this year, 25% of vendors said they won’t be ready until the second or third quarter of 2015.

Like Robin Williams shouting, “Good morning, Vietnam!”, the results of this WEDI survey are a brash wake-up call. The switch to ICD-10 is coming, and even if it does happen to be delayed yet again, there’s no sense in delaying your preparations on the off-chance we get an extension. Take advantage of the six months we have left before the deadline, and make sure you’re as prepared as possible. Need help getting there? Check out these handy resources.

Fiscal Therapy: How to Develop an ICD-10 Budget

March 31st, 2015
ICD-10, Preparation

At this point, you should be ankle-deep in ICD-10 preparations, which means you’ve probably spent a whole lot of time staring at your clinic’s finances and trying to figure out how the heck you’re going to cover the cost of switching. (And if you haven’t started prepping, here’s how to get started.) I’d love to provide you with a one-size-fits-all budget, but that’s just not possible. Every clinic’s ICD-10 transition will be just a bit different from the rest based on its specific needs and characteristics.

As a general rule of thumb, your ICD-10 prep budget needs to account for all the factors that will cost you time, money, or both (time is money, after all). These include:

  • Technology upgrades or new software and/or hardware
  • Staff training on coding and new technology
  • Productivity loss during training, testing, and and the period immediately following the transition
  • Temporary staffing to cover gaps due to preparatory activities and productivity lags
  • Contract changes with vendors and payers
  • New coding guides/superbills

Handy tools like the free Healthcare Information and Management Systems Society (HIMSS) ICD-10 Cost Prediction Tool account for many of your clinic’s variables, but even if you cover all your bases, you can’t guarantee your payers will be as prepared as you are—and that can spell trouble for your practice. If payers aren’t prepared to process claims containing ICD-10 codes, you’ll need a contingency plan to offset any cash flow delays. Your best bet is to have plenty of cash on hand (but not under the mattress) to keep your practice afloat. So get ready, get set, and get to saving three to six months’ worth of cash revenue.

Is saving that much money not an option for your clinic? Consider turning to your bank for a new loan or increasing an existing line of credit. Fair warning: If you go this route, you’ll need to assess your practice’s financial needs and work with a partner who understands the particulars of the healthcare industry. Keep in mind that lenders usually require lots of paperwork, including:

  • three years’ worth of tax returns and year-to-date financials
  • a current personal financial statement
  • your most recent accounts receivable aging report

For more assistance regarding financial planning with your bank, check out this awesome list of ICD-10 cash flow tips from Wells Fargo.

However you acquire and allot your funds, be sure to nail down your plan soon. The transition to ICD-10 happens on October 1, 2015—just about six short months away. Will you be ready?

Seven Months Left: Your ICD-10 Survival Guide

March 24th, 2015
ICD-10, Preparation

The year keeps marching on, and we’re already fewer than seven full months away from the mandatory transition to ICD-10. It’s time to get going on your ICD-10 preparations so you don’t find yourself dead in the water come October. If your prep game is on point, then you’ve already amassed a veritable library of ICD-10 resources and determined your clinic’s ICD-10 champion (or champions). But you can’t stop there, so we’ve put together a list of what you need to do over the next seven months to finalize your clinic’s preparations for the switch.

March: The Once-Over

To make sure the transition to ICD-10 doesn’t sink your ship, you’ll need to take a good, hard look at your practice and inspect it from sails to keel, port to starboard, bow to stern, and everywhere in between. Here’s how to get your magnifying glass into every nook and cranny:

  • Determine your current diagnosis coding processes and run an ICD-10 compliance audit to ensure those processes can accommodate the new codes.
  • Figure out how your staff currently interacts with ICD-9 codes, and pinpoint the ones they use most frequently; then, learn their ICD-10 equivalents. This also is a good time to decide if you need to hire a coder.
  • Double-check with your external vendors (like your billing service, EMR, and payers) to verify their ICD-10 preparedness. If they aren’t ready or don’t even have a plan in place, you might want to take your money elsewhere. And if you’re in the market for new software, make sure you consider ICD-10 functionality when choosing your vendor—and plan ahead to give your staff enough time to get comfortable with the new program before the ICD-10 switch.
  • Cover your financial bases by creating an ICD-10 clinic budget. Don’t forget to include costs related to technological and software upgrades, training courses for your staff, and coding guides and superbills.

So, why must you dive into all these details? To develop an effective game plan. Based on the information you uncover, you and your ICD-10 champions will create a to-do timeline for your clinic that gets everyone involved and up-to-speed in a timely fashion.

April-September: Training Day(s)

At this point, spring has sprung—and we’re leaping into the final six months before the ICD-10 transition. This six-month stretch—during which you’ll enact your plan of action—will be crucial to your success. This is an all-hands-on-deck process, so remember to include even those staff members who may not be directly impacted by the switch to ICD-10. With so many different folks on your team, training can be tricky, so here are a few tips to help you lead the way:

  • Be a good DJ. Chances are, the members of your team have a variety of different learning styles, so when it comes to your educational approach, you’ve got to show off your mixing skills.
  • Bend—don’t snap. Switching code sets is a huge change, so be patient and flexible with your staff while they learn the new structure. Basically, don’t be like Denzel Washington’s character in Training Day.
  • Seize the moment. Each day is a new opportunity for you and your staff to engage in ICD-10 training, so get crackin’. Bring back some high school memories with pop quizzes, and add in practice exercises to work those ICD-10 muscles. Remember to acknowledge those staff members who really dedicate themselves to learning the new code set.

May-September: Clinic Tested; Payer Approved

The first day of fall (September 23, in case you were wondering) will be here before we know it; before that date hits, you’ll want to make sure your vendors have their ICD-10 ducks in a row. Testing for ICD-10 compliance may seem complicated, but avoiding it could lead you into rough seas once we transition to the new code set. My advice:

  • You need to test. No ifs, ands, or buts about it. Test internally and externally.
  • Again, check with your vendors. This time, make sure you know how they plan to test, if at all (though all vendors and practitioners should be testing at some point before October).
  • Once you know your vendors’ testing plans, take advantage of them to ensure preparedness for both parties. It would be bad news bears to find out after the switch that you, your partners, or—worse—all of you weren’t ready.

October 1, 2015: You Did It!

Treat yo’ self with a pat on the back, and take a moment to thank your staff for putting so much hard work into making your ICD-10 transition smooth sailing.

So, there you have it: your seven-month countdown of ICD-10 preparations. Easy peasy, right? Okay, maybe not, but I can assure you that all that prep work is well worth your time. Looking for more in-depth preparation information? Check out our webinar for a complete ICD-10 prep checklist.

Testing, Testing: Results from the November ICD-10 Acknowledgement Testing Week

January 6th, 2015
ICD-10, Preparation, Testing Week

November wasn’t a great month for turkeys, but it was a great month for the Centers for Medicare & Medicaid Services (CMS). More than 500 participants—including small and large physician practices, small and large hospitals, labs, ambulatory surgical centers, dialysis facilities, home health providers, ambulance providers, and several other physician specialties—submitted almost 13,700 test claims during a successful week (November 17–21) of acknowledgement testing.

CMS held this testing week to ensure the organization is able to accurately receive, process, and reimburse claims containing ICD-10 codes. The trial run also allowed participants to practice documentation and billing practices to ensure their workflows suit the new diagnosis codes.

CMS made certain that each test claim submitted during the week included all of the information required for processing, including:

  • Valid diagnosis code
  • Matching dates of service
  • Valid National Provider Identifier (NPI)
  • ICD-10 companion qualifier code

CMS rejected some claims due to both intentional errors—that is, those part of the “negative testing” process, which ensures erroneous claims aren’t accepted—as well as unintentional errors, including:

  • Invalid NPI
  • Future dates of service (CMS requires that all test claims use current dates of service)
  • Missing ICD-10 companion qualifier codes

Overall, testing went well. The system experienced no issues, and CMS accepted 76% of the submitted test claims, with the daily acceptance rate improving steadily over the course of the week to a high of 87% on Friday.

If you missed this particular testing week, don’t worry. CMS is offering two more testing weeks this year: March 2–6, 2015, and June 1–5, 2015. That being said, providers, suppliers, billing companies, and clearinghouses aren’t limited to testing claims just during these weeks; they can submit test claims anytime before ICD-10 officially goes into effect on October 1, 2015.

For more information on the testing process or to learn how to participate, contact your Medicare Administrative Contractor.