Clockwatching Time Is Over – Are You Ready for ICD-10?

icd-10 countdown, icd-10 ready, icd-10 implementation, icd-10 transition, icd-10 training

When I was a child, I loved to watch digital clocks flip from 11:59 to 12:00. These were the old timey clocks with little cards for the hours and the minutes, where you could actually watch the mechanism flop the number cards over.

How does this relate to the ICD-10 countdown? I’ve been watching the ICD-10 clock too, and it just flipped to the big day. If you’ve read the last eight SuperCoder blogs, you know we’ve been talking nonstop about ICD-10. Each day, I hopped over to the CMS webpage Road to 10 website to stare in fascination at the CMS clock, transfixed by how quickly the remaining days, minutes, and seconds flipped by. Check the “Countdown to the October 1, 2015 ICD-10 Compliance Date” today, and you’ll see it shows the time in the negative.

Government Shutdown and Another ICD-10 Delay Averted

As the hours passed on September 30, I worried that some last-minute I-10 killer might surface. After all, Congress was threatening to shut down the government again; as ICD-10 Watch’s Carl Natale speculated, it would have been pretty easy for some Congress member to slap a codeset-killing rider onto a last-minute budget measure. Fortunately, we seem to have escaped that fate; Congress passed its temporary budget measure Wednesday afternoon without mention of ICD-10.

AHIMA Members: “Let’s Just Do It”

In the meantime, the American Health Information Management Association (AHIMA), holding its 87th Annual Conference in New Orleans this week, saw attendance unchanged from last year. That indicates that health information management professionals are ready for the ICD-10 implementation, said AHIMA CEO Lynne Thomas Gordon, ‎MBA, RHIA, CAE, FACHE, FAHIMA in an interview with Healthcare IT News. “I don’t think we’d have this great turnout if [HIM professionals] were all worried about ICD-10,” Gordon said. She added that at the convention’s kickoff ceremony on Monday, when a speaker mentioned ICD-10’s imminent arrival, “the audience broke into spontaneous applause — we are ready,” Gordon said. “Let’s just do it.”

CMS Has a Plan — An ICD-10 Contingency Plan

According to Politico, CMS created an ICD-10 contingency plan to handle several different scenarios, including problems with claims submissions and payments, so keep an eye on Road to 10 and the CMS Medicare coding page for developments. Also, don’t forget that you can email any problems to CMS’s ICD-10 Ombudsman, William Rogers, MD, at icd10_ombudsman@cms.hhs.gov.

Post-Implementation Practice Watch List

We’ve also heard repeatedly that while acute care organizations and big health plans have been ready for a while, some smaller practices had challenges getting set up for ICD-10. Now that it’s October 1, you may not be processing ICD-10 claims today, but you will be shortly. Here are some things to look out for, according to AHIMA’s Mary Beth Haugen, RHIA, MS.

1. Expect Coder Productivity to Drop.

Haugen predicts a productivity drop of as much as 50 percent at first, depending on the quality of coder training and clinician documentation. Managers should compare current performance to coding stats from ICD-9, expecting an initial dip with a gradual increase. If you don’t see an increase, find out if coders need more education in specific areas. Check whether documentation gaps are causing the problem. Ask coders if other factors cause them problems.

2. Monitor Documentation Queries.

Inpatient facilities need to watch numbers of concurrent (while patients are in the hospital) and retrospective (after discharge) queries to compare them to baseline. Practices should monitor queries in general. If you see an increase, determine if it’s localized to a particular service line or provider and go from there. Consider whether providers are overloaded by an increased number of queries and address as appropriate.

3. Watch Your A/R Days.

Keep an eye on your accounts-receivable (A/R) days to make sure they don’t rise immediately after ICD-10 goes live. A rise in A/R days could be your first clue to a coding problem.

4. Keep Track Of Pre-Authorizations.

Make sure the orders and referrals that your providers process include ICD-10 codes—and make sure those codes are as specific as they can be.

5. Track Claim Edits, Denials, and Days to Payment.

Depending on your organization’s revenue cycle flow, you may not see a payment impact from the changeover until mid to late October. Starting October 1, track and trend payer responses, including specific edits and necessity denials, and find ways to fix those problems.

Also watch days to payment. This will help you find payers that struggle to process claims. You can report problems and explore known issues at the ICD-10 Issue-Reporting Database maintained for public use by The Workgroup for Electronic Data Interchange (WEDI).

6. Monitor Your Revenue Cycle Flow.

Make sure your patient claims flow as they should for both Medicare and commercial payer cases. From patient registration to claim review and charge capture to the clearinghouse to the A/R followup, your claims should be moving smoothly. Keep a close eye on this for the first 10 days after ICD-10 go-live, and correct any issues. And maximize your cash reserves as much as you can.

So, Did You Remember to Breathe This Morning?

Seriously, how are things going for you now that it’s October 1? We’d love to hear from you–just pop a note in the comment box below.

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About 

Susan taught health information and healthcare documentation at the community college level for more than 20 years. She has a special love for medical language and terminology. She is passionate about ensuring accurate patient healthcare documentation through education. She has a master's degree in healthcare administration, is a certified healthcare documentation specialist, and serves as immediate past president for the Association for Healthcare Documentation Integrity (AHDI).

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