After the Oct. 1 Deadline: Key Considerations for ICD-10 Implementation

BY JILLIAN PEDROTTY
PPRC SPECIALIST

With the implementation of ICD-10 on the horizon, physician practices should be gearing up for the conversion taking place October 1.

CMS, in conjunction with the AMA, recently announced that it will allow for flexibility in the claims auditing and quality reporting process for the first year until the medical community becomes acclimated to the new coding system. For one year, Medicare claims will not be denied or audited solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes. CMS will also establish an ICD-10 ombudsman and communication center to assist physicians during the transition, and will authorize advanced payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation.

But it is still vital for practice managers to be prepared to implement ICD-10 and make payment and other metric comparisons between pre-ICD-10 and post ICD-10 implementation. The following are some key

considerations:

  • Beware of Payment Delays: It is important to note that reimbursement may be delayed as payers get accustomed to the new coding system. Focus on consistent and proper documentation, which directly impacts accurate code assignment, billing, and payment timing.
  • Watch Reimbursement: During the adjustment phase, it will be extremely important to monitor reimbursement across plans. Assigning a point person to monitor reimbursement with particular attention to reconciling payments to charges submitted will help to measure the impact of implementation to the practice. If payments are taking longer than usual for any particular payer, consider reaching out to the payer to investigate the reason and determine if there are any operational process changes at the practice level that would help.
  • Monitor System Glitches: Identifying and addressing possible glitches in your practice’s electronic systems is critical and can help deter potential operational problems. Having a plan in place that all staff are aware of in the event that problems do occur is extremely crucial. Consider who the point person should be, what the appropriate chain of escalation looks like and being sure that all staff are aware in order to facilitate working through the challenge in a timely manner.

 

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