We are approaching a day many of us thought might never come – and many still hope won’t come. There is proposed legislation to delay, modify, or completely abandon ICD-10 implementation, but there is no indication any of those bills will pass (though we’ve been surprised before). Across the industry, there are still mixed results regarding readiness. Many payers, health systems, and vendors have stated and proven they are ready. Many still have the non-reassuring words “we will be ready” in their material. For those not yet ready, there is a delicate balance between admitting you might not be ready while clinging to the hope that you will be.
Our ICD-10 transition team has worked to get Medac in as strong a position as possible as the implementation date approaches. This includes updates to critical systems and processes, training of staff, data gathering for feedback to our providers, and payer testing.
The Kam billing system has been fully updated to support ICD-10. The updated system has been in use since May. Medac has the ability to capture both ICD-9 and ICD-10 codes on each case, and determine which to bill based on carrier settings. Medac will capture both codes initially, but will be able to turn off the ICD-9 settings, by payer, once we have a comfort level that each payer is accepting and correctly processing ICD-10 codes.
Staff training began two years ago with formal on-site training by the American Academy of Professional Coders along with a supplemental web-based training module, and has continued with our coders coding in ICD-10 on a regular basis. We have steadily increased the time spent coding in ICD-10 over the past several months. We closed August with all coders coding ICD-10 on 50% of cases and are on pace to have 100% of cases coded in ICD-10 beginning September 14th.
Medac instituted a two-phased training approach. Phase 1 consisted of a web-based, self-paced training module designed to introduce the concepts of ICD-10 documentation. If you are a Medac provider and have not received the login for this tool, please contact your Practice Manager. Phase 2 consists of outlining actual documentation deficiencies from our live coding. These deficiencies were categorized and outlined in the attached Documentation Resource Guide.
Most payer testing is by invitation only. Where Medac has been invited, we have participated. For those payers with open testing, the selection criteria has been extremely strict and Medac was not selected in many instances. Further, many payers we submit claims to don’t even offer testing. Medac undertook an aggressive payer testing campaign and was successful in direct testing with over a dozen payers, large and small, from all regions of the country. Further, we have worked closely with our clearinghouse to leverage their extensive industry-wide testing and have confirmed that Medac can successfully submit to Availity, who can successfully submit to the payers.
The Bottom Line
There are risks everywhere you turn with ICD-10. Some may go away as quietly as Y2K while others may turn out to be even worse than we feared. The challenge is that no one entity controls all the pieces – we all must count on each individual organization in the industry to implement correctly to avoid problems that directly impact us. We are confident that Medac has done its part to control those elements within our control and we have identified teams to quickly surface issues that are out of our control and take any corrective action available.
Frequently Asked Questions
Q: What should I expect to happen on October 1st?
A: Nothing. In fact the ICD-10 frenzy may be very quiet through the first week or two of October. Most payers are implementing ICD-10 starting with October 1st dates of service, so depending on your date-of-service to date-of-bill timeline, your claims may not even get to the payer until well after October 1st. From there, problems may not surface for a couple more weeks until the payer adjudicates the claims. Again, Medac has done everything we can to ensure readiness, but a quiet October doesn’t necessarily mean the storm has passed.
Q: How does my documentation stand against ICD-10 requirements?
A: The attached Documentation Resource Guide addresses the deficiencies identified on live cases across all Medac groups. Most issues were consistent across all groups. The best way to evaluate your diagnosis documentation against the ICD-10 requirements is to review this guide and compare to what you generally document in each scenario defined. You will undoubtedly see areas where new items are required that you do not normally capture.
Q: Does my diagnosis have to match the surgeons?
A: The answer is most likely, “no”, but this could be a requirement in some cases. The key factor is how the payer uses its claim edits. My belief is that most payers will not take their claim edits this far. Further, due the significant changes in ICD-10, I believe matching diagnoses across all providers will be nearly unachievable, at least initially. That said, there is nothing preventing a payer from taking this stance.
Q: Are there any tips or general guidelines that will help with ICD-10 documentation?
A: The ICD-10 codeset is nearly 4x bigger than the ICD-9 codeset, with each diagnosis range expanding into its own set of specific details. There is no “silver-bullet” to easily capture all ICD-10 requirements for each diagnosis category. However, there are some central themes that apply to most categories. These are:
- Laterality: Right, left, or bilateral
- Location: Specific organ/body area, and the specific site on the organ/body area
- Cause: Infection due to ___, injury due to___, disease due to ____
- Contributing or Exacerbating Factors: HTN, Diabetes…
- Type: If the condition has multiple manifestations, list which is applicable
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The information presented herein reflects general information that is current as of the date it was first published. In light of changes that may occur in the health care regulatory and compliance environments, the author’s presentation of this information might become outdated. Please check with your individual legal and/or compliance advisor(s) prior to taking any significant actions based upon the information and advice presented.