Creating an ICD-10 Action Plan: Possible Effects and Office Awareness

If you are hoping the medical coding transition from ICD-9 to ICD-10 won't really happen on Oct. 1, 2014, or won't have that much of an effect on your medical practice, you may want to think again.

"ICD-10 is here, so we have to deal with it," said Robert Tennant, senior policy adviser for the Medical Group Management Association's government affairs department, at the organization's recent annual conference in San Diego. "…This is probably the biggest challenge we in healthcare face since [President Lyndon] Johnson signed into law Medicare."

Since the transition affects everyone in the chain of care from physicians to patients, Tennant advised medical practices to start creating an action plan and get staff trained sooner rather than later. And the first steps are to understand ICD-10 and its potential effect on your office.

"This will impact the entire patient encounter," said Tennant. "There is no indicator that the government is going to do away with ICD-10 … [and it is] highly unlikely anything will change between now and October 2014."

In terms of determining the effect on your practice, one critical area to assess is whether the transition will require changes to software your practice is currently using, including your EHR and practice management system, said Tennant. If you software isn't ready for the change, your practice may not be either.

 "Get it in writing from vendors," Tennant said. "Don't just take their word [that they'll be ready]."

The transition will also affect reimbursement and contracting, said Tennant, noting that practices should contact their health plans to see how their expectations will change once ICD-10 becomes a reality. "The concern, for me, is that each individual health plan may have individual payment policies … so you may have different approaches to payment," Tennant said. "The answer is to try and get as strong a documentation that you can at the time of the encounter as possible" to help get paid on-time, every time.

So how does you practice make sure it has all its bases covered? Tennant advised creating an internal ICD-10 team, comprised of senior management, medical staff, billing/coding staff, information systems, and others. Also create a spreadsheet to track the steps your practice takes to prepare for the transition and any issues that come up along the way.

"The best thing, as with all changes, is to get a physician champion," Tennant said.  "It'll make thing easier."

Ironically, when looking at building internal awareness of the change at your practice, another part of Tennant's proposed action plan, you'll likely face pushback from those same physicians. He advised informing them that the compliance date is not moving and explaining the consequences - from rejected/pended claims to cash flow issues.

"Convince them that this is important," he said. "Explain the impact of three, four, five months of not being paid." Tennant also advised educating each staff member regarding the direct effect ICD-10  will have on their department and on office operations. He recommended peer-to-peer education, where one staff member gets training and passes it to another, distributing tools and resources, and networking with local colleagues to identify and solve problems.

This is the first of three articles on Tennant's proposed "action plan" for medical practices to prepare for ICD-10.  Stay tuned to the ICD-10 Topic Resource Center for future installments.