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.


New Survey: Practitioners Confident in Preparation, But Concerned About Costs

March 10th, 2015
ICD-10, Preparation

The healthcare industry at large has faced the music: everyone is switching to ICD-10 on October 1, 2015. That means every HIPAA-eligible professional is finally in the full swing of preparation, but seeing as how experts have been urging folks to prepare for roughly two years now, it’s unsettling that most of those practitioners still feel unprepared. According to a Healthcare IT news article summarizing a recent survey from Navicure and Porter Research, only 21% of physician practices surveyed said “they’re on track with their preparations for the switchover.” But while physician practices are running behind the preparatory timeline, they’re not crying about it. On the contrary—they’re actually “optimistic,” the Navicure and Porter Research survey revealed. Furthermore, a whopping 81% of practices surveyed are “confident they will be ready for the transition.”

Even though private practice physicians are confident they’ll be ready before the deadline, the study did highlight some immediate concerns: According to HIT Consultant, 41% of those surveyed aren’t sure if “they’ve budgeted for ICD-10,” and 59% “are most concerned about ICD-10 cash flow impact and revenue.” Other cited concerns included questionable payer readiness and potential productivity lags. While payer preparedness is out of practices’ control, they can control productivity—to an extent. As Navicure explains in its survey report, “Even with a well-trained staff, industry estimates indicate that staff productivity will decline by 52 percent for the first 3-6 months following the transition.” And decreased productivity has a ripple effect: “Lower productivity means slower claims turnaround and slower reimbursement.”

In addition to sharing the survey results, Navicure also emphasized some key takeaways, which I’ve summarized below.

  1. Many survey respondents said they were waiting on vendor software updates to test ICD-10. My advice: Don’t wait for your vendors. There are ways to test internally without vendor involvement.
  2. Develop a budget ASAP, and investigate how partnering with your bank and improving your billing processes can help ease the financial burden of the transition.
  3. Plan for decreased productivity, and pinpoint how to mitigate it. One way to do that? “Trend denials pre- and post-implementation to benchmark performance and fully monitor revenue cycle efficiency and staff productivity,” explained Navicure.

While Navicure and Porter Research surveyed private practice physicians, the results likely ring true for many PT practices, too. Feeling a bit unprepared yourself? Don’t sweat it; check out this webinar for your ultimate ICD-10 to-do list.


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.


End-to-End Testing Volunteer Applications Due January 21

December 30th, 2014
ICD-10, Preparation, Testing Week

Despite recent buzz about yet another ICD-10 delay, as of now, the implementation of the new diagnosis code set will go forward as planned on October 1, 2015. To prepare for the transition, Medicare will conduct a second round of end-to-end testing with a new sample group of providers this April. As with the previous end-to-end testing exercise, this effort will verify that:

  • Providers and other claim handlers are able to submit Medicare claims containing ICD-10 codes
  • Medicare’s software can correctly process claims containing ICD-10 codes
  • Claim submission results in accurate remittance advices

CMS will select approximately 850 test participants from its pool of volunteers. This sample will represent a wide variety of geographic locations, provider types, and claim submission processes. Want to get in on the action? Here’s how to throw your hat in the volunteer ring:

  1. Visit your local MAC website to get a volunteer form.
  2. Complete the form and turn it in by January 21.
  3. Keep your eyes peeled for a selection notification from CMS.
  4. Receive further testing setup instructions from CMS by January 30 (if you’re selected).

Please note that all volunteers must be able to submit future-dated claims as well as provide valid National Provider Identifiers (NPIs), Provider Transaction Access Numbers (PTANs), and beneficiary Health Insurance Claim Numbers (HICNs). If you are selected for testing and are unable to provide this information to your MAC by February 20, 2015, CMS will eliminate you from the test group.

CMS has an additional end-to-end testing period planned for July 20–24, just a hair over two months before the go-live date. As a side note, those who volunteer to participate in the April testing exercise don’t need to reapply for the July test.

CMS will use the data it collects during the testing week to address any lingering ICD-10 issues and develop appropriate educational materials, thus ensuring a smooth transition come October 1.

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


Don’t Delay Your ICD-10 Prep

June 19th, 2014
ICD-10, Preparation

You’ve heard it plenty by now: ICD-10 has been delayed until October 1, 2015. But just because Congress delayed the inevitable doesn’t mean you should dilly-dally on your prep work. After all, the early bird gets the worm, and in this case, the well-prepared bird will experience a smoother transition and more accurate reimbursements. Sounds like a good worm to me. Need further convincing? Here’s why you shouldn’t delay your ICD-10 prep:

Change is inevitable.

When faced with change, many of us like to dig our heels into the ground and resist to the bitter end. Perhaps that’s why ICD-10 got delayed for the third time earlier this year. As Jon Lindekugel, the president of 3M Health Information Systems, explained, “The vote to delay ICD-10 is a vote for the past, not the future of health care.” But whether we switch to ICD-10 or skip right to ICD-11, we will not use ICD-9 forever. Change is inevitable, and resistance is futile, so why bother? Embrace the change; address it straight on. The sooner everyone prepares, the better off we’ll be. (See bit above about early birds and worms.)

There’s a lot to do.

ICD-10 requires a good deal of preparation, including:

With so much to do, time truly is of the essence. It behooves you and your practice to have as much time as possible. In other words, don’t procrastinate.

Wasting dollars doesn’t make any sense.

ICD-10 will have a significant impact on finances. In fact, the AAFP advises providers to have at least three months’ worth of extra cash revenue available, while others recommend having at least six months’ worth on hand. If you can’t save that much, Heidi Jannenga suggests “having a plan B, such as a line of credit or supplemental income to ensure your clinic’s viability during the transition.” In line with the theme of this blog, though, she warns not to wait on this because “you’ll have to vie for financing and pay higher interest rates.” Ultimately, the longer you hold off on preparing for ICD-10, the more at-risk your practice will be for inaccurate reimbursements or worse, denied claims. As Avery Hurt explains in this Physicians Practice article, “Thorough preparation is the key to sailing through this transition with your finances in good shape.”

How are you handling the ICD-10 delay? Now that you know why you shouldn’t procrastinate, what are you doing to move your prep plans off the back burner?


CMS’s ICD-10 Testing was a Success

June 5th, 2014
ICD-10, Preparation, Testing Week

You may remember the ICD-10 testing week that the Centers for Medicare and Medicaid Services (CMS) conducted in March of this year. Well, the results are in, and it was a success. Participants submitted more than 127,000 claims containing ICD-10 codes to Medicare “and received electronic acknowledgements confirming that their claims were accepted,” writes Niall Brennan, acting director of the CMS Offices of Enterprise Management, in the May 30, 2014, CMS ICD-10 News Update (which the Mississippi Hospital Association republished here).

About 26,000 providers, suppliers, billing companies, and clearinghouses (representing approximately 5% of the total submitting population) participated in the testing program, with clearinghouses making up the largest portion of participants and submitting half of all test claims. On the national level, CMS accepted 89% of test claims (the normal acceptance rate is 95–98%). However, some regions reported acceptance rates close to 99%.

According to Brennan, the “testing did not identify any issues with the Medicare [fee-for-service] FFS claims system”—which is great news—but the program did afford testers and CMS the opportunity to learn. “To be processed correctly, all claims must have a valid diagnosis code that matches the date of service and a valid national provider identifier,” writes Brennan. “Additionally, the claims using ICD-10 had to have an ICD-10 companion qualifier code…” Claims lacking any of the above were rejected. Brennan reports that many program participants intentionally submitted errored claims to ensure the rejection process was working correctly—a process known as “negative testing.”

The Department of Health and Human Services (HHS) plans to release an interim final rule that will include October 1, 2015, as the new mandatory ICD-10 compliance date. Under this proposed rule, HIPAA-covered entities will need to continue using ICD-9 through September 30, 2015. However, “providers, suppliers, billing companies, and clearinghouses are welcome to submit acknowledgement test claims anytime up the anticipated October 1, 2015, implementation date.” However, Brennan cautions, you may want to wait to do so until after October 6, 2014, when Medicare will complete its system updates. If you’re interested in conducting acknowledgement testing, please contact your local Medicare Administrative Contractor (MAC) for more information.

CMS will soon release details about another round of end-to-end testing slated for next year. We’ll pass along that info as soon as we receive it.

For more ICD-10 news, visit the CMS ICD-10 website, sign up for ICD-10 email updates, or follow CMS on Twitter. Also, check back here often.


How to Conduct External Testing for ICD-10

May 28th, 2014
ICD-10, Preparation, Transition

In a previous blog post, we explained how and why you should test the ICD-10 code set inside your practice. Now, let’s talk about external testing—that is, verifying that all of your outgoing and incoming data transmission processes are completely ICD-10 ready. That way, by the time the transition date—which is set for October 1, 2015, according to recent hints from CMS—rolls around, there will be no question of whether you’ll get paid.

In this article, ICD10Watch editor Carl Natale explains the importance of proper external testing. In his words, such testing should allow you to:

  1. “Verify that [your] practice can submit, receive, and process data containing ICD-10 codes.
  2. “Understand the impact that clearinghouse and payer policies will have on the transactions.
  3. “Identify and address specific problems.”

If you find the task of architecting—and executing—a comprehensive external testing plan to be more than a little overwhelming, relax. As Jennifer Bresnick writes in this EHR Intelligence article, you should employ a “multi-phase approach to testing to cover different testing objectives in a reasonable time frame…” Essentially, treat ICD-10 testing as you would a fine dining experience; you wouldn’t scarf down your appetizer, entrée, and dessert all at once, and you don’t want to dive into all portions of your testing at once.

Instead, break it down into stages, and be sure to set specific, measurable, attainable, relevant, and timely (SMART) testing goals. Then, present your goals and target deadlines to your staff as well as your business partners and vendors. As you’re formulating your plan, be sure to research where your partners are in their own ICD-10 preparations. That way, you’ll know where you might need to build a little bit of cushion into your schedule so you don’t get derailed by surprise setbacks.

Natale pulled the following key action items from the external testing plan CMS provides here:

  • Pinpoint and prioritize the parties with whom you need to test
  • Make arrangements to submit test claims to your clearinghouse, billing service, and/or payers
  • Analyze the results of your test submissions
  • Adjust your clinic’s processes accordingly

Furthermore, according to this article, CMS and the Workgroup for Electronic Data Interchange (WEDI) recommend that you perform testing with claims representing all of the code categories your practice uses, especially those that may be susceptible to “common errors, such as mistaking a zero for [the letter] O” so that you will see what happens if your claims don’t go through. And regarding test claims that contain real patient data—a.k.a. protected health information—take heed of these cautionary words from the American Medical Association (AMA): “Be sure to follow all appropriate security and privacy measures to protect the data, such as sending the transactions using a secure connection.”

If your practice only works with a certain clearinghouse or billing service, you’ll have a simplified external testing experience because you really only need to ensure they can receive the codes. However, you should also confirm that such parties are conducting their own testing initiatives with payers and other clearinghouses. Otherwise, it could affect your cash flow.

While many experts recommend that you dedicate six to nine months to your external testing endeavors, we say the more testing you can do, the better. So as we count down the weeks and months to transition time, keep a pulse on your partners’ testing preparations so you can get started as soon as you’re ready.

Does your clinic have a plan for external ICD-10 testing? What testing questions do you have? Share your thoughts in the comment section.


How to Test ICD-10 Inside Your PT Practice

May 21st, 2014
ICD-10, Preparation

Mandatory implementation of ICD-10 is slated for October 1, 2015 (at least that’s what Medicare has implied). That means your physical therapy practice has just the right amount of time to properly prepare. One key aspect of preparation is testing, both inside and outside of the clinic. Later this month, we’ll cover how to test with entities outside of your practice. Today, though, let’s discuss testing within your practice to ensure that your staff can correctly use the new codes and that each internal process works.

Before You Begin

  1. Nail down the list of people at your practice who interact with codes (e.g., billers, front office staff, and therapists).
  2. Identify your practice’s most frequently used ICD-9 codes and their ICD-10 equivalents.
  3. Learn how your staff identifies correct ICD-9 codes and how they plan to do that with ICD-10 codes.
  4. Determine whether those processes make the best sense for the new code set.

Implement Dual Coding

To confirm that your staff can correctly use ICD-10 codes, we recommend dual coding, or reporting and verifying both the ICD-9 code and the correct ICD-10 equivalent for all patients. Not only will this help you and your staff get acclimated to the new code set, but also it will allow you to identify the ICD-10 codes most frequently used in your practice and specialty. Note that most payers are not currently accepting ICD-10 codes, and many may not accept them before the official transition date. So check with your payers before submitting any claims featuring both ICD-9 and ICD-10 codes.

Test Internal Processes

Depending on how your practice currently codes, you may need to alter your current coding processes. For example, with ICD-10, it’s important that PTs select ICD-10 codes that address the exact patient condition they’re treating as opposed to simply carrying over the referring physician’s codes. Once you understand your current processes, test them for ICD-10, and then adjust accordingly. Continue this method until your clinic establishes workflows that truly work for ICD-10 across all teams and applications.

Have you started testing ICD-10 within your practice? What advice do you have for other PTs?


New Research Finds Less than 10% of Physician Practices Ready for ICD-10

March 20th, 2014
ICD-10, Preparation, Testing Week

The Medical Group Management Association (MGMA) published the findings from their most recent ICD-10 readiness survey and the results are, well, scary. According to Jeff Wood in this ICD-10 Hub blog post summarizing the findings, the researchers found that “less than 10% of physician practices have made significant progress toward preparing for the upcoming conversion to ICD-10.” While this demonstrates an improvement from MGMA’s June 2013 survey, it’s not much.

For physicians, one of the issues may very well be their EHR. The survey found that:

  1. Most (almost 87%) need to—or already had to—upgrade or replace their EHR software to use the new codes. Almost 37% have/had to cover the cost—$12,885 per full-time physician.
  2. Only about 8% have started internal ICD-10 testing with their EHR vendor.

It’s not just MDs who are less than raring to go. Wood writes that “almost 60% of the 570 medical groups polled had not heard from their payers about when end-to-end testing would begin” and “nearly 50% [of respondents] had not received a testing date from their clearinghouse.” Despite the results of this readiness survey, there’s been no news about another transition date delay—although I’m sure many providers and payers were hoping that would be the case.

So what does this mean for PTs, OTs, and SLPs? We’ll, it means it’s a great time to be a therapist. Although the transition to ICD-10 may not be a total picnic, you’ve got a lot less to worry about than your physician counterparts. For starters, your EMR implementation costs are a fraction of that frightening figure above. And you don’t have to demonstrate meaningful use this year in addition to making the transition to the new super specific coding set. And that means you and your team can focus solely on learning—and implementing—the new codes. And if you’re a WebPT Member—or plan to become one—you have an EMR that will ensure everything is working smoothly well before the transition deadline. Plus, all of our billing software partners are ready (or almost ready), too. Some—like Therabill and Medisoft—are already accepting ICD-10 codes (along with their ICD-9 counterparts) and most—including CollaborateMD, AdvancedMD, and Kareo—participated in Medicare’s ICD-10 Testing Week to verify their own ICD-10 readiness.

Want to learn more about WebPT and our integrated billing partners? If you’re already a member, head to the Community section of WebPT by clicking the people icon in the top-right corner of any screen within the application. If you’re not yet a member, call us at 866-221-1870, option 1.

What do you think about the survey findings? Tell us your perspective in the comments section below.


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.