ICD-10 Implementation: Five More Facts to Know Now
By - Last week, RevCycleIntelligence.com presented the top five facts to know now about ICD-10 implementation, as reported by the Centers for Medicare & Medicaid Services (CMS).
Here are five (more) facts to know now, as announced by CMS.
Knowledge is power
There are many widely accepted myths circulating among healthcare providers, payers, and professionals about the upcoming implementation of ICD-10, the tenth revision of the International Classification of Diseases. Some perceptions are factual. However, some of them are merely rumors.
It is imperative accurate information is dispersed and recognized throughout the healthcare industry. Seeking to better inform the industry, CMS recently connected with an array of healthcare providers to pinpoint the most common misperceptions about the ICD-10 transition and clarify erroneous concepts.
The following information will hopefully clarify even more general myths and dispel industry-wide confusion about the possibility of transition delay, daunting code volume, procedure codes, reimbursement costs, and available technological resources.
1. Consider alternate electronic claim submission opportunities
Tick tock, tick tock goes the ICD-10 clock. CMS urges healthcare providers to be successfully geared up for the October 1, 2015 ICD-10 implementation date. Some providers will not be ready, says CMS.
Is this you? If so, take a deep breath, as alternate assistance to aid preparation will be provided. Medicare offers a variety of options for healthcare providers who may experience technological glitches with their systems while submitting ICD-10 diagnosis codes, says CMS.
Available options include free billing software, downloadable from every Medicare Administrative Contractor (MAC), Part B claims submission functionality on MAC’s provider internet portal for half of MAC jurisdictions, and the submission of paper claims if Administrative Simplification Compliance Act waiver provisions are effectively met, states CMS.
CMS recommends any healthcare providers planning to utilize the above options allot additional time for staff preparation and billing software and portal training prior to October 1.
2. There are limitations regarding ICD-10 claim submission
Those healthcare practices that fail to adequately prepare for the ICD-10 transition implementation deadline will be unable to submit claims for any services performed either on or after October 1, states CMS. Only those claims coded with ICD-10 will be accepted for services provided on or after October 1, says CMS. Such submissions can be performed either electronically or via the above alternative methods described, CMS adds.
3. ICD-10 diagnosis codes do not determine reimbursement
Contrary to popular belief, ICD-10 diagnosis codes do not determine reimbursement for outpatient and physician office procedures, says CMS. Outpatient and physician office claims are paid on CPT and HCPCS procedure codes. Payments are not granted in connection with ICD-10 diagnosis codes. CPT and HCPCS procedure codes are not changing, CMS confirms.
However, similarly to how ICD-9 codes are currently being used, ICD-10-PCS codes will indeed be used for hospital inpatient procedures. CMS additionally confirms ICD diagnosis codes will occasionally be used to determine medical necessity without relation to a particular care setting.
4. ICD-10 software and systems costs may be nominal, or free
According to CMS, ICD-10 costs may be much lower than was initially anticipated. Many vendors of electronic health records (EHRs) are including ICD-10 in their systems or their upgrades at little cost -- or even no cost -- to their customers.
The estimated costs of ICD-10 conversion for a small physician's office are between $1,960 and $5,900, according to a recent study from Thomas C. Cravis, MD, Susan Belley, Med, RHIA, Donna M. Smith, RHIA, and Richard F. Averill, MS (Cravis, et al) within the American Health Information Management Association (AHIMA). Such data is much lower than that previously reported via a widely referenced 2008 report from Nachimson Advisors to the American Medical Association (AMA) with estimated costs ranging between $22,560 to $105,506, confirm Cravis, et al.
The average ICD-10-related expenditure for a physician practice with six or fewer providers is $8,167, with average expenditures per provider of $3,430, states additional research from Karen Blanchette, MBA, Richard Averill, MS, and Susan Bowman, MJ, RHIA, CCS (Blanchette, et al) from The Professional Association of Health Care Office Management (PAHCOM). “These results represent the most comprehensive and current data on the ICD-10 implementation costs actually being incurred in small physician practices,” confirm Blanchette, et al.
5. The time to transition to ICD-10 is…now
As Robert M. Wah, MD, President of the American Medical Association (AMA) confirmed in a recent interview with RevCycleIntelligence.com, “As an industry, we need to ensure that the transition to ICD-10 is smooth and there are adequate contingency plans in place to prevent large-scale interruptions in claims processing and reimbursement.”
CMS echoes this statement within their fifth fact, stating, “ICD-10 is foundational to modernizing health care and improving quality.” ICD-10 is indeed a building block that allows for increased specificity, CMS adds.
The added benefit of standardized data results is a hearty plethora of advantages, says CMS. These include improved coordination of a patient’s care across providers, the advancement of public health research, public health surveillance, and emergency response via detection of disease outbreak detection adverse drug events, the encouragement of innovative payment models to enhance care quality, and enhanced fraud detection efforts.
Transitioning from fiction to fact
Education is a key element of success for the healthcare industry as the October 1 deadline for ICD-10 implementation looms nearer. There are indeed many financial challenges of ICD-10 preparation. Hopefully, at least one of the ten total facts has impacted your perception of what needs to get done...now...to strengthen your own individual and collective efforts. Get ready, get set, prepare!
