ICD-10 Conversion

ICD-10: Preparing for the Conversion

August 2014

After months of deliberation, the US Department of Health and Human Services (HHS) issued a rule on July 31, 2014 that finalized the compliance date for ICD-10 transition to October 1, 2015. According to a joint survey by eHI and AHIMA, 40 percent of participants said they would be ready to conduct end-to-end testing by the end of 2014; 25 percent will be ready by the end of 2015. MedSynergies is moving forward, well ahead of the deadline. As one of the first groups to conduct end-to-end testing with a payor, MedSynergies is well on its way toward ICD-10 compliance.

Background

ICD, or International Classification of Diseases, is the standard code set for classifying diseases and other health problems on health records. The U.S. Government's deadline for switching all HIPAA-covered entities to ICD-10 was originally scheduled for October 2014, but has been delayed until October 1, 2015.

ICD-10 represents a significant improvement over the aging ICD-9 code set. Converting to the new standard will affect nearly every facet of a provider’s operations, including care delivery, patient services, and revenue cycle management, as well as data analysis and reporting.

The upcoming conversion offers several opportunities for notable performance improvement. The robust ICD-10 code set allows for greater accuracy and clinical detail, resulting in significant improvements in the quality and usefulness of coded data and greater specificity in a patient’s diagnosis and inpatient procedures. Medical terminology and disease classification have also been updated for consistency with current clinical practice. In addition, ICD-10 has an enhanced structure and capacity to capitalize on advances in technology. These more flexible systems are able to accommodate revisions driven by ongoing medical advances, newly developed diagnoses and procedures, as well as innovations in treatment. ICD-10 also allows for detail in Clinical Quality Measures (CQMs), which can improve the accuracy of medical data in clinical processes. Data from the CQMs will furnish valuable feedback on provider performance, as well as inform communication and decisions on policy and clinical support.

Potential benefits include:

  • Greater accuracy in payments for new procedures
  • Fewer miscoded and rejected claims
  • Better insight into the value of new procedures
  • Improved understanding of outcomes
  • Better analysis of disease patterns
  • Improved public health tracking
  • Better detection of fraud and abuse
  • Detailed data on injuries and accidents

ICD-10 Effect on Revenue Cycle

The transition may affect the critical operation of revenue cycle management. Understanding the alignment of new ICD-10 codes to existing ICD-9 data will be crucial in maintaining efficient billing and coordination of benefits. Any claims using ICD-9 codes on or after the compliance date cannot be paid. There may also be opportunities to incorporate the more specific capabilities of ICD-10 to optimize processes and procedures to more accurately reflect services provided.

MedSynergies' ICD-10 Success

Though lawmakers in Washington have postponed implementation of ICD-10 until 2015, MedSynergies teams have been moving forward ahead of mandate.

"Although the ICD-10 implementation has been delayed, where we can do end-to-end testing with a payor, we are doing so," says Jeanett Robertson, Vice President, Compliance and Internal Audit, and executive sponsor of the ICD-10 project. "Even if Congress had not delayed ICD-10, we would be ready. This is validation of what MedSynergies has done so far and it says to our clients that we are capable."

MedSynergies Inc. is working on the rollout now to ensure a successful transition for our clients. So far, MedSynergies has successfully completed ICD-10 acceptance testing with CMS and end-to-end testing for Texas Health Physicians Group, with United HealthCare Medicare/AARP.

MedSynergies' testing involved numerous scenarios.

"For each database, we created test files for the integration team to submit to Medicare to see if it passed the new ICD-10 diagnosis edits for claims," says Sophia Olds, A/R Revenue Cycle Manager for the private practice legacy team. "We made each test file reflect what a typical, daily Medicare claims batch submission would look like for each of these practices." In doing so MedSynergies could test to make sure that if clients were to submit codes in ICD-10, the payors would accept and reimburse in the same way if the charges were submitted using ICD-9 codes.

In the case of Texas Health Physicians Group, with United HealthCare Medicare/AARP, the ICD-9 claims were copied into test systems and recoded using ICD-10 codes. The electronic claim files were then sent through three different systems to the payor. As a result, the payor was able to confirm that they would reimburse the test claims in exactly the same way as the original ICD-9 claim. Achieving this level of success so early in testing is a huge step towards ICD-10 readiness for MedSynergies.

Another key factor to MedSynergies’ success is offering one integrated ICD-10-compliant solution so all systems match organization-wide. Each system has the same list of codes and the same strategy for sending out the claims correctly, which creates consistency across all platforms and allows for best practices when working with multiple clients on multiple systems.

Finally, having the flexibility to accommodate payors where they are in the conversion will also allow for a smooth transition. By taking advantage of the Crosswalk feature offered with MedSynergies billing systems, the system can code all claims using ICD-10 codes, but send claims to payors in ICD-9 or 10, depending on the payors’ progess.

Making a Smooth Transition

Transitioning to ICD-10 is more than just converting codes, extending data fields or investing in new compliant systems. This migration affects every aspect of the healthcare industry, from nurses to billing specialists, from coders to front desk staff, from physicians to patients, and includes providers, physicians, health care clearinghouses and payors.

To make the transition successful and ensure timely compliance, Gabe Navalta, MedSynergies’ program manager for ICD-10, recommends focusing on three vital steps in the process. “Train the physicians and coding staff early and get them using ICD-10 as soon as possible,” he advises. “Review documentation and workflows and make adjustments before October 1 to ensure the transition is smooth.” And most importantly, he emphasizes to “Test, test, test. Basically, the more you do early the less of an impact go-live will have.” 

Training Physicians and Staff

Competence in computer-assisted coding will increasingly become routine. Even those staff members that do not interact regularly with ICD coding today will require a baseline level of understanding to ensure they are aware of the significant changes and how they will affect the organization. Medical coders, naturally, will require the highest level of training. Some staff may only need training on diagnostic and procedure coding, while other personnel will require additional training on anatomy and physiology.

Physicians will require training on the clinical aspects of ICD-10 as it relates to their specialties. But additional focus on clinical documentation will help ensure that a proper explanation of patient condition and services is provided so the coder can assign the appropriate ICD-10 code.

Workflow Review

To ensure the necessary procedures and materials are in place for every area affected, a workflow review should be implemented to identify the readiness and sustainability for applying, processing, and translating coded data in the new format, including:

  • Clinical documentation changes (encounter forms, medical record templates)
  • Coding practices and processes
  • Revenue cycle process
  • Patient communications (appointments, reminders, brochures)

Test, Test, Test

Finally, end-to-end testing is the most critical step in the ICD-10 conversion. Because the new codes do not correspond exactly with existing ICD-9 codes, incorrect codes will negatively affect reimbursement.

"This transition is definitely going to happen, and we are continuing our testing, never really knowing what we're going to face," says Gabe Navalta. "But we're committed to making sure we contribute to the client's successful transition.”