Here are 10 basic steps for ICD-10 implementation in surgery centers, based on information provided by CMS. Visit the CMS website to learn more about ICD-10 implementation.
1. Identify your current systems and work processes that use ICD-9 codes. This could include your clinical documentation, encounter forms/superbills, practice management system, electronic health record system, contracts and public health and quality reporting protocols. It is likely that wherever ICD-9 codes now appear, ICD-10 codes will take their place.
2. Talk with your practice management system vendor about accommodations for both Version 5010 and ICD-10 codes. Contact your vendor and ask what updates they are planning to your practice management system for both Version 5010 and ICD-10, and when they expect to have it ready to install. Check your contract to see if upgrades are included as part of your agreement. If you are in the process of making a practice management or related system purchase, ask if it is Version 5010 and ICD-10 ready.
3. Discuss implementation plans with all your clearinghouses, billing services and payors to ensure a smooth transition. Be proactive; don't wait. Contact organizations you conduct business with, such as your payors, clearinghouse or billing service. Ask about their plans for the Version 5010 or ICD-10 compliance and when they will be ready to test their systems for both transitions.
4. Talk with your payors about how ICD-10 implementation might affect your contracts. Because ICD-10 codes are much more specific than ICD-9 codes, payors may modify terms of contracts, payment schedules or reimbursement.
5. Identify potential changes to work flow and business processes. Consider changes to existing processes including clinical documentation, encounter forms and quality and public health reporting.
6. Assess staff training needs. Identify the staff in your center who code, or have a need to know the new codes. There are a wide variety of training opportunities and materials available through professional associations, online courses, webinars and onsite training. If you have a small center, think about teaming up with other local providers. You might, for example, be able to provide training for a staff person from one center, who can in turn train staff members in other centers. Coding professionals recommend that training take place approximately 6 months prior to the Oct. 1, 2013, compliance date.
7. Budget for time and costs related to ICD-10 implementation, including expenses for system changes, resource materials and training. Assess the costs of any necessary software updates, reprinting of superbills, training and related expenses.
8. Conduct test transactions using Version 5010/ICD-10 codes with your payors and clearinghouses. Testing is critical. Allow yourself enough time to first test that your Version 5010 transactions, and subsequently, claims containing ICD-10 codes are being successfully transmitted and received by your payors and billing service or clearinghouse. Check to see when they will begin testing, and the test days they have scheduled. If you submit electronic claims, you need to have completed internal testing of Version 5010 systems in time to begin external testing with your payers, clearinghouses, billing services and other business partners by Jan. 1, 2011.
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1. Identify your current systems and work processes that use ICD-9 codes. This could include your clinical documentation, encounter forms/superbills, practice management system, electronic health record system, contracts and public health and quality reporting protocols. It is likely that wherever ICD-9 codes now appear, ICD-10 codes will take their place.
2. Talk with your practice management system vendor about accommodations for both Version 5010 and ICD-10 codes. Contact your vendor and ask what updates they are planning to your practice management system for both Version 5010 and ICD-10, and when they expect to have it ready to install. Check your contract to see if upgrades are included as part of your agreement. If you are in the process of making a practice management or related system purchase, ask if it is Version 5010 and ICD-10 ready.
3. Discuss implementation plans with all your clearinghouses, billing services and payors to ensure a smooth transition. Be proactive; don't wait. Contact organizations you conduct business with, such as your payors, clearinghouse or billing service. Ask about their plans for the Version 5010 or ICD-10 compliance and when they will be ready to test their systems for both transitions.
4. Talk with your payors about how ICD-10 implementation might affect your contracts. Because ICD-10 codes are much more specific than ICD-9 codes, payors may modify terms of contracts, payment schedules or reimbursement.
5. Identify potential changes to work flow and business processes. Consider changes to existing processes including clinical documentation, encounter forms and quality and public health reporting.
6. Assess staff training needs. Identify the staff in your center who code, or have a need to know the new codes. There are a wide variety of training opportunities and materials available through professional associations, online courses, webinars and onsite training. If you have a small center, think about teaming up with other local providers. You might, for example, be able to provide training for a staff person from one center, who can in turn train staff members in other centers. Coding professionals recommend that training take place approximately 6 months prior to the Oct. 1, 2013, compliance date.
7. Budget for time and costs related to ICD-10 implementation, including expenses for system changes, resource materials and training. Assess the costs of any necessary software updates, reprinting of superbills, training and related expenses.
8. Conduct test transactions using Version 5010/ICD-10 codes with your payors and clearinghouses. Testing is critical. Allow yourself enough time to first test that your Version 5010 transactions, and subsequently, claims containing ICD-10 codes are being successfully transmitted and received by your payors and billing service or clearinghouse. Check to see when they will begin testing, and the test days they have scheduled. If you submit electronic claims, you need to have completed internal testing of Version 5010 systems in time to begin external testing with your payers, clearinghouses, billing services and other business partners by Jan. 1, 2011.
Related Articles on Coding, Billing and Collections:
New Jersey Assembly Committee Approves Health Insurance Exchange
Texas Considers Publicizing Information on Health Insurance Rate Hikes to Consumers
Aetna Sues 7 California Surgery Centers Over Alleged Overbilling