Three Ways to Avoid the Negative Effects of ICD-10 Payer Un-readiness

dr_EHR / February 4, 2016

The International Classification of Diseases, Tenth Edition (ICD-10) is a clinical cataloging system developed by the WHO and modified by the CMS and other stakeholders in the US into the ICD-10-CM and ICD-10-PCS. The deadline for this system’s implementation is October 1, 2015. If you are involved in providing healthcare or administrative services the odds are, you will be required to make sure that all your systems are compatible with the ICD-10 system before the set deadline.

The Centers for Medicare and Medicaid Services administrator Andy Slavitt was quoted as saying “ICD-10 is the beginning of better diagnosis and identification of early warning signs of Epidemics like Ebola.”

Nonetheless, there are many challenges that you should be adequately prepared for. Payer readiness is one such major factor that you must put into consideration in order to avoid incurring losses and encountering bigger implementation challenges. ICD-10 codes are designed to provide for more classification options. These classifications are significantly more in comparison to those found in its predecessor, ICD-9. To avoid the negative effects of payer un-readiness here are some important measures that you should take:

Link ICD-9 and ICD-10 Codes

In every transition, some of the involved operators are not well-prepared even when the set deadlines loom. ICD-10 transition is not an exception with the payer readiness pegged at 71% according to a survey by Medicare. Due to payer un-readiness, your practice will need to have the ability to submit to payers linking both the currently used ICD-9 and the transition ICD-10 codes. Moreover, it will be your responsibility to monitor the ICD-10 readiness of each of your payers.

Through this monitoring, you can know the diagnosis codes to administer to each of the payers. This instance of un-readiness if not well prepared for can cost your practice a significant amount of money and time. To avert all these challenges, make sure that your vendor updated your system so it that can easily and effectively submit the right codes to the right payers. Your updated systems should: 

  • Guide users to the correct ICD-10 codes
  • Convert back to ICD-9 codes automatically in the background 

This conversion will enable you to offer the correct codes to payers who have not entirely made the transition. Additionally, your practice will be adequately shielded against the billing process challenges arising from the transition.

Evaluate Existing Reimbursement Patterns

Make sure that you are well-aware of all your existing reimbursement patterns. These patterns will assist you to gauge effectively your volume of MVA and WC claims. Thus, you can evaluate the corresponding effects on coding and billing operations. Through these assessments, you will come up with effective strategies that will avert all the possible negative effects of ICD-10 payer un-readiness. This strategy is necessary for you especially if your practice does not have a cloud-based services partner.

ICD-10 Payer Testing

Liaise with a cloud-based services provider who will help you evaluate the extent of every one of your payers’ readiness to transit to ICD-10. These cloud-based networks have many providers as their clients with millions of claims and solid connections with payer organizations. Thus, they will help you to: 

  • Assess payer readiness
  • Conduct ICD-10 testing outreach extensively on your payers
  • Engage your payers in testing engagements 

Through this testing, you will identify all payers at risk of failing to beat the transition deadline. Therefore, you can minimize your engagement with these kinds of payers.

People tend to resist change. Adopting the three strategies above will help your ENT practice avoid the negative effects of payer unpreparedness.