The ICD 10 transition deadline is Oct. 1, 2015—and many software vendors are scrambling to release new tools to help clients achieve compliance. In fact, the most recent industry survey by the Workgroup for Electronic Data Interchange (WEDI) shows only 60 percent of vendors have relevant products ready for purchase or claims testing.
Yet billing and practice management software is a key factor in a successful transition. Depending on your needs and budget, your software should help you manage one or more of these essential stages in the ICD 10 transition process:
ICD 10 Transition Stages
Practitioners can use this article to explore the ICD 10 transition stages and learn how ICD 10 software can help make each stage easier so they can achieve a seamless code-set conversion. While all of the software products listed here perform multiple functions, we’ve highlighted capabilities from each that are most relevant to a particular transition stage.
Why it’s important: Whether you’re a solo practitioner or part of a multi-doctor organization, creating an action plan can help you prioritize the necessary tasks for the big conversion. By making a road map and breaking it up into manageable steps, the idea of a code set overhaul won’t seem quite as overwhelming.
How software helps: When your ICD 10 conversion plan is created in a medical software system rather than on paper, it’s easy for every person on your staff to access the plan, track their progress and stay accountable. No one can lose the plan or ruin it with coffee stains. And tasks can be added or subtracted in one place instead of juggling multiple documents.
Example tool: Kareo’s ICD 10 planning functions are part of its practice management software. An interactive “ICD 10 Success Dashboard” allows for comprehensive planning by providing both “Practice Readiness” and “Individual Readiness” checklists for each user, with tasks (e.g., “Complete a crosswalk for the top 100 frequently used codes”) that can be ticked off when completed. Users can see the status and estimated completion date for each item at a glance.
Why it’s important: Coding errors can delay or halt reimbursement payments for your practice, forcing you to go through a potentially lengthy appeals process to get the right amount. While CMS promises leniency for a full year post-transition if your codes aren’t specific enough, it’s still your responsibility to submit a valid, appropriate ICD 10 code for every patient encounter.
How software helps: There are nearly five times as many ICD 10 codes as ICD-9 codes—so it will take a while for staff to feel comfortable with all of the changes. In a busy medical office, no one has time to pore over 69,000 codes in search of the right one. Luckily, tech tools can help quickly narrow down the options.
Example tool: PracticeSuite’s practice management software facilitates multiple methods of finding codes through its “ICD 10 Coding” window. The “Fav ICD codes” tab, for example, lists your most used ICD-9 codes from the past 36 months alongside the corresponding ICD 10 codes based on General Equivalency Mappings (GEMs): a CMS-backed conversion reference tool. The system also offers direct searching of the ICD 10 Alphabetical Index and Tabular List.
Why it’s important: One of the best ways to predict how your practice will fare with ICD 10 is by conducting a series of practice runs with test claims. You have several different partners you can test with before Oct. 1, including:
- Your own staff
- CMS (contact your Medicare Administrative Coordinator for details)
- Your software vendor
- Your clearinghouse
- Individual health plans (payers)
How software helps: The right system can help you keep track of which types of codes should be prioritized for testing, how successful your practice was in testing them and what workflow changes must be made to optimize the process going forward.
Example tool: The ICD 10 SuccessTracker is a tool included in AdvancedMD’s electronic health record (EHR) and practice management software. The “Top Code Analysis” tab lets users note commonly used ICD-9 codes and whether they should be prioritized for claims testing. In the “Chart Audit” tab, users can enter notes or documentation supporting an encounter’s ICD 10 code. And that tab’s “Notes” section lets you list issues that may affect the claim submission (e.g., whether the clinician should have entered more robust documentation to support a certain code).
Why it’s important: Stumbling blocks are predicted on the way to ICD 10 compliance: Experts say practices could see up to a 60 percent productivity drop as resources are diverted to implementation. Reimbursement shortfalls are expected, as it could take longer for payments to come in. Claims may be delayed getting out the door as your team adjusts to the new code set, and payers might experience processing delays.
How software helps: Since the entire claims system is bound to be rife with holdups throughout the conversion, it will be more important than ever to catch potential coding errors before they leave your office. Luckily, software can make this easier for you. Many systems have functionality that can not only help identify coding mistakes, but also suggest solutions.
Example tool: The ICD 10 functions in NueMD’s medical billing software will alert you of possible errors before your claims are sent to a clearinghouse. The “Claims Edit” claim-scrubbing tool audits every patient encounter code before it’s submitted. If a claim is missing information, you’ll see exactly what kind of edit is needed, which code set you should use to fix it and a link to the record. And this software performs dual coding, so you won’t mix up ICD-9 with ICD 10.
Why it’s important: Starting Oct. 1, only ICD 10 claims will be processed. And beyond this mandate, ICD 10 is expected to benefit the entire U.S. health care system, bringing better documentation of patient care and improved tracking of illnesses over time.
How software helps: While CMS offers options for providers who are unable to submit ICD 10 claims electronically, there are many advantages to using medical software: For example, once the claims data is entered, it’s sent to the provider’s clearinghouse and scrubbed for errors (for a fee) before being sent to the payer. Doing this instead of submitting claims directly to the payer saves time, money and can help increase claim acceptance rates.
Example tool: American Medical Software’s practice management system offers functionality to ease ICD 10 claims submission. When you enter a charge, you can code it using ICD-9 and ICD 10 code sets. Since providers must keep submitting claims using ICD-9 until Oct. 1, it is important to find a system that can submit claims in either set. This way, your usual workflow won’t be disrupted when the deadline hits.
Which of These Tools Does Your Practice Need Most?
The tools featured here are meant to facilitate a smooth ICD 10 conversion. However, choosing the right ones for your practice’s particular needs isn’t an easy decision.
That’s where our team of Software Advisors comes in: In just 15 minutes, they can provide a free phone consultation to help you build a shortlist of medical systems that are a good fit for your practice. Let them help you choose a solution with ICD 10-ready tools to simplify and streamline your workflow—and keep your reimbursements coming in without a hitch.
Alternatively, just email me at firstname.lastname@example.org for free help researching the right software for your practice.