The Delay Is an Opportunity — Not a Reason to Put Off Action
As of this writing, the U.S. House of Representatives has passed the bill delaying ICD-10 until at least Oct. 1, 2015.
Now you’re probably wondering what to do next. Although the answers are different for each stakeholder group, there’s one certainty: if you check out, you’ll lose out.
So let’s talk about how you can make the most of the extra time, based on where your organization is in the preparation process.
If you haven’t started or have barely begun, you’re still a month behind, even with the delay.
Start right, and start right now. If you start today, you’ll still be a bit behind schedule.
So don’t wait for updated recommendations. Only one thing has changed: now you actually can complete the critical tasks before implementation arrives – if you hustle.
Don’t assume that your current lack of readiness precludes you from starting to test with Medicare and other payers. Ask your clearinghouse to help facilitate testing — ideally, it should offer you an easy way to stay apprised of your payers’ testing status and provide workarounds if your PM or other systems don’t yet support ICD-10 codes.
Even though there’s more time to test, remember that there’s no guarantee the delay will result in many more opportunities for testing. Some may still be one-time-only, and that’s one more reason to act now.
If you were ready to go, get ready to ROCK!
Hold your vendors to their stated timelines – think of the coming months as a stress test. For example, if a vendor promised an upgrade to support dual coding by April, it should still deliver on that promise. If they don’t, it raises questions about their readiness and commitment, now and in the months ahead.
Keep your coders on the path to greatness – ask them to code at least a few claims in ICD-10 every week, or challenge them to master a subset of claims that are particularly difficult to code or that have an especially large impact on your organization’s bottom line. Coders who stop using their ICD-10 skills will lose them, while coders who further develop these skills will be the best in the business.
Help your physicians and other clinicians see the value of continuing to produce clinical documentation detailed enough to support ICD-10 coding now. The increased specificity that ICD-10 requires – including metrics such as laterality, trimester, and even smoking status – has implications and benefits far beyond those of ICD-10. Detailed clinical documentation will help your coders select more specific ICD-9 codes, which are less likely to be rejected or under-reimbursed. In addition, many of these details are required to meet PQRS standards, and detailed documentation improves the quality of health records and reduces your organization’s risk of medical errors caused by missing or incomplete information.
Seek out opportunities for end-to-end testing with payers – be persistent and proactive. If ICD-10 is delayed, there’s far less justification for payers to limit their opportunities or criteria for testing.
Remember, the more you test, the fewer rejections and denials you’ll experience when ICD-10 does go live.
If you’re somewhere in the middle, you’re at a crucial tipping point – and you can choose success.
Many of the above recommendations apply to you as well – don’t become complacent, hold your vendors accountable, and test, test, test.
What’s unique is that you’re well-positioned to move ahead quickly but deliberately. You already have some insight into where you need to improve, but you may not have yet made significant investments in ICD-10 preparations. That means you’re ready or nearly ready to select your training resources and ICD-10-related solutions in a now well-established and competitive marketplace. Unlike early adopters, you can check satisfaction ratings and get recommendations from vendors’ current clients before you make purchasing commitments.
If you haven’t completed a detailed ICD-10 readiness assessment, do so as soon as possible. The point isn’t to confirm that you aren’t fully ready; it’s to show you exactly where to focus your efforts.
Then explore your options. There are resources and solutions specifically designed for every size and type of healthcare organization. Choose the ones that best suit yours.
A delay in ICD-10 isn’t solely a reprieve; seize the opportunity now to plan, train, test, and prepare. The clock has been reset, but that doesn’t mean it has stopped ticking. Recognize the delay for what it truly is: a call to action.
About the Author
Betty Gomez is the vice president of regulatory strategy at ZirMed and and member of the Cooperative Exchange.
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