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Ready or not, here it comes: ICD-10 for home health and hospice providers

Time to Think Ahead: ICD-10 Deadline Set for October 2014

Starting October 1, 2014, every entity covered by HIPAA will make the transition to using ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System). Now, we know that’s a mouthful of an acronym, but fear not: ICD-10-PCS will be used only in inpatient hospital settings, so your home health agency will no longer have to use procedure coding. ICD-10-CM, on the other hand, is used for diagnosis coding and will be required in all U.S. health care settings, including hospice providers and home health agencies.

If this seems overwhelming, don’t worry: there’s time. And we’re here to break it down for you in simpler terms. You might have some questions, so we’ll do our best to answer them.

We made the update to 5010 and it didn’t go so well. How can we expect ICD-10 to be any different?

For some, the transition to HIPAA 5010 was not a smooth one. A study conducted at the end of 2012 by KLAS entitled Clearinghouse Services 2012: Yesterday 5010; Tomorrow ICD-10 revealed that thirty percent of healthcare providers struggled with payment delays during the transition. Over half of the delays are believed to have been caused by clearinghouses. If your organization was affected by payment delays, we can understand why you might be concerned about similar problems occurring in the ICD-10 transition. Below are some ways you can prepare.

But why the change, why now?

It might seem sudden, but ICD-9 has turned the big 3-0 and its limitations have become clear. Structurally, many categories of ICD-9 are full and the number of new codes that can be created is limited. We’re also falling behind: ICD-10 has been the standard for the international standard for years.

First, the good news: you might be more ready than you think.

By upgrading to 5010, you’ve already completed the first step. Give yourself a big pat on the back! More good news: with the implementation date delayed until October 2014, you not only have time to prepare, you have time to be proactive.

So, what can we do right now?
  • For starters, check with your billing service/clearinghouse/home health software vendor about how they intend to handle the transition. This is especially important for those of you who may have been unhappy with how your clearinghouse handled the 5010 transition.
  • Create a transition timeline. Consider these questions
  1. Who needs to be trained?
  2. How much training will they need? (AHIMA estimated that proficiency can be achieved after 16 hours of training and 10 hours of practice, so prepare your employees accordingly.)
  3. When will this training occur? (See “crunch time” below)
  4. How will this transition impact your organization?
  5. What is a realistic transition budget your organization can commit to?
  • Keep your eyes peeled for the new OASIS data set, OASIS C-1. While there isn’t currently a known release date, we do know that there will be revisions designed to support the switch to ICD-10 coding.
What can we do in the coming months?
  • You’ll want to begin working with your clinicians’ to ensure their knowledge is up to date before they begin learning the new code sets. ICD-10-CM is more detailed and complex than the ICD-9 we’ve all spent the last 30 years with, so revisiting their anatomy, pathophysiology, medical terminology, and pharmacology background will be helpful.
  • It’s never too early to start familiarizing yourself with the ICD-10 codes. Start with determining their ICD-9 counterparts to gain your footing.
When should we consider it “crunch time”?

To be on the safe side, you should begin training the ICD-10 code set no later than April of 2014 (six months out), but closer to February 2014 (nine months out) is recommended. Get yourself an ICD-10 manual and dive right in. If you’ve completed your timeline, you should already have training scheduled for your coding staff, but make sure you’ve arranged for their coding responsibilities to be covered while they’re in training.

And there you have it.

Yes, the transition might be a bit sticky for awhile, but ICD-10 is not without benefits. It is another step in the journey of improving the efficiency and cost-effectiveness of our health care system. With the right attitude and preparation plan, you can help your organization sail through this change with minimal challenges.

Looking for more information? This document (PDF) from Selman-Holman & Associates is helpful.

If you’ve already started getting ready, we’d love to hear your approach plan! Share in the comments below.

keep calm and prepare for ICD-10

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