Managing the Transition to ICD-10
On October 1, 2015, the healthcare industry made its transition from coding system ICD-9 to ICD-10. The transition was necessary because the previous coding system was over 30 years old and considered to be outdated and not aligned to today’s medicine. The new coding system is said to improve the quality of care and provide higher-quality data for measuring quality, safety, and efficacy.
Other benefits from the transition include: improved outcomes measurement, greater opportunity for research, improved public health reporting, decreased claims submissions, fewer rejected claims, reduced coding errors, reduced labor costs, increased productivity, and reduced potential healthcare fraud and abuse.
Healthcare organizations, providers, and payers prepared for this transition for years prior. The good news for medical practices is that concessions have been made to make the implementation to ICD-10 a little easier. Physicians can take comfort knowing that The Centers for Medicare and Medicaid Services (CMS) will not deny claims for the first year, as long as they use the proper code family. There will also be advanced payments made if there are any issues processing claims due to the transition.
Practices should have already made the switch to ICD-10. The following are a few suggestions for the continued management of the transition:
- Assess progress- practices should compare performance to previous years and track rates of rejections and denials.
- Anticipate additional time spent on documentation. One study found that documentation activities would increase by 15 to 20 percent due to longer and more detailed coding sets. Which means physicians will need to be more detailed in their descriptions to receive proper reimbursement.
- Anticipate denials, delays, improper claims payments, and decreased cash flow as a result of the transition to ICD-10. Be sure to promptly correct and resubmit any denied claims. Analyze documentation and code selection as needed to help prevent future issues and fix current ones.
- Develop a feedback system- create a process for gathering feedback and questions from staff and for sharing ICD-10 insights.
- Monitor cash flow until claims under ICD-10 are consistently paid.
- Monitor all reimbursement for payer accuracy and timeliness.
For additional information:
Practices can download the 2016 Code Tables and Index at:
Download the CMS Next Steps Toolkit, which is a free resource that offers additional suggestions and recommendations.