With all of the changes that have, and will, take place with the Affordable Care Act, healthcare providers have enough changes swirling around their practice. But one thing that strikes fear into the hearts of many is the impending switch from ICD-9 to ICD-10.
Between claim denials from incorrect coding and coders taking more time with the new system, billing is likely to slow down dramatically as of October 2, 2014. But experts say preparation and planning should keep their accounts receivable from stalling altogether.
[See also: 3 phases for ICD-10 implementation]
“We absolutely see there being (claim) denials, but we know there are ways to prevent the bulk of that,” said Cynthia Stewart, director of ICD-10 training and education for AAPC, a medical coding training and education association.
Main hiccups
There are two main things that will slow down billing after the transition, Stewart said. First is the more in-depth level of documentation that will be required. It will no longer be sufficient for a coder to send a bill for an open wound, for example. Now they will have to drill down to whether or not it is a bite or other kind of wound, if there is or isn’t a foreign body, and exactly what part of body it’s in (i.e. the right forearm). She recommends having coders train doctors on increased documentation.
Another challenge is that coders often don’t even read bills any longer. Stewart said those that have been working in the position for a while just skim the pages. The descriptors under ICD-10 will be longer and include words like “with” or “without” which are easily read over. They will now have to read codes, and their “productivity will drop dramatically,” she said.
Check in with payers
Many of the major payers are saying they are prepared for the conversion. Medicare and larger organizations like Blue Cross Blue Shield have the resources to devote to projects like this. But Lisa Gallagher, vice president of technology solutions at HIMSS, the parent company of Healthcare Finance News, recommends testing with your business partners in advance, particularly smaller organizations and those not required to take part in the transition, like workers’ compensation.
“You don’t want to end up at the deadline testing it when you submit something for the first time,” she said.
Stewart recommends talking with payers and vendors – anyone that will have some attachment to claims – to find out which ones might not be ready for the conversion. She said to ask questions like what they need for proof of filing and what they plan to do if a physician files properly but they aren’t able to pay in a 90-day time frame.
“If they can’t pay in your time frame, what kind of interest rate can you expect on money that they weren’t able to adjudicate?” she said. “They might not be able to offer anything, but it is worth a shot.”
Plan with CMS
It will also be worth it to get as much information from the Centers for Medicare & Medicaid Services (CMS) before conversion as possible, Stewart said. CMS is currently rewriting their coverage determination policies and will be assisting local carriers in rewriting theirs as well. Medicare is slated to have their policies completed before the go-live date.
Stewart urges providers that have a heavy Medicare population to get this information ahead of time. Providers can work through the new policies, take a sample of their bills and recreate what they have in their electronic medical records or paper bills.
Expect to be denied
Providers have to understand that claims will be denied and create a strategic plan, experts said. Gallagher said physicians will get a break because instead of denying the claims, CMS plans to send them back for recoding if there are problems with the bill.
“That is their opportunity to get it right,” Gallagher said.
What providers need to prepare for is what to do when claims are returned. Gallagher said providers need to know who is going to recode the bills; what the process is when that happens and who will monitor the rejected claims for cause.
If there isn’t enough funding for new staff to take on these tasks, Stewart recommends reallocating staff. And if that isn’t feasible, she said to find out appeal limits and sort claims based on that time frame. Begin with those that have the shortest time frame first and sort from largest dollar amount to smallest – they can be tackled in that order.
Most importantly, Gallagher said to start preparing because CMS isn’t planning on changing the deadline again.
“We constantly get asked that question and so does CMS, so we need to make sure we get the message out to everyone,” she said.