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ICD-10 Questions and Answers

Healthcare Management Consultant David Zetter, the founder and lead consultant with Zetter HealthCare, recently answered questions regarding ICD-10 for an administrator of multiple practices.  The questions that were asked by the administrator are in bold below.  We think these are questions you may also have regarding ICD-10, and Mr. Zetter™s answers provided below each question will benefit you and your organization.

In addition, we are happy to announce that for a limited time, our ICD-10 Primer module is FREE.  After you have had a chance to review the questions and answers below, please feel free to contact us, if you haven™t already, for access to our ICD-10 Primer module.

1How should physicians, particularly small medical practices, be preparing for the upcoming ICD"10 transition? Is there a standard step"by"step process or best practices to follow?

Physicians should have already determined what their list of ICD-9 codes are that they used in 2014 and converted them to ICD-10 for their staff and a list for themselves (crosswalks documented in writing).  This allows for much quicker process in pre-loading of charts and encounters prior to the visit to convert ICD-9 codes from previous visits to ICD-10 codes prior to the provider visit.  This will also help providers choose the proper code so they are not having to search in the EHR and long descriptors for the codes.

Additionally, the providers should have documentation reviews completed to ensure they are documenting the FULL descriptor of ICD-9/ICD-10 codes so that if they experience any pre- or post-payment audits, they will not have the payors keep or recoup payments due to the documentation not supporting the billed diagnosis code.

Lastly, providers should communicate with their bankers to ensure they have extended Lines of Credit to ensure cash availability should such pre- and post-payment audits actually occur that constrict their cash flow

2What should be their primary focus to ensure things go smoothly?

Talk to staff to determine their concerns in the use of ICD-9 codes that will change to the use of ICD-10 codes to ensure their continued success in the organization and whether they feel they have the tools to do the job properly.

 

3. Is this something they can coordinate themselves or do they need outside help?

Many practices need outside help.  We have a flood of clients and practices that are not clients clamoring for assistance at the last minute in trying to prepare knowing they are unprepared for this transition.  We even had a client come to us saying that their EHR is requesting the ICD-10 codes from the practice to load into the EHR.  Most EHRs are loading the ICD-10 package into their systems.  Apparently, some are not.

4. Is there still time to initiate a plan or is it too late for practices who havent begun planning back"up procedures?

There is always time.  This is going to be a 1-10 year process.  In some cases, practices see patients every 2-10 years (gastro, cardiology, etc) based on the patient needs and preventive care.  Previous charts and encounters will need to be converted.  Documentation is ALWAYS a challenge for providers and now that Payors have license to conduct even more pre- and post-payment reviews, they will be able to recoup much more money from practices that are not documenting medical necessity properly due to documentation not matching codes billed.

 

5. Any other information he can provide about an ICD"10 contingency plan,Im happy to hear it!

It is never too late to put a plan into place.  Even if it is just to verify your plan is going to work.  If you wait until you get audited, it still isn™t too late, because you will need to learn to correct the mistakes that are causing your cash flow drop.  It will take time for everyone to get used to this, the practices and the payors.  There will be many payors that will start recouping monies more quickly than others, but this is just another way practices have to ensure they keep the monies in their coffers.

We hope these questions and answers Mr. Zetter provided will help you and your practice.  We also hope the ICD-10 Primer module will also help you and your practice as the ICD-10 go-live date is just over 20 days away.

If you have any questions or would like to access the ICD"10 Primer training module FREE of charge, please feel free to send us an email [email protected].com or reach us by phone toll"free 855"427"0427.

 

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