ICD-10 advice: Leverage your payers and vendors

We are at a pivotal point with mere months to the ICD-10 mandate go-live date of Oct. 1, 2014. Still, significant numbers of providers have not even begun to prepare and now CMS has emphatically stated it will not budge on the implementation date.

It has never been clearer – physician practices must be able to code in ICD-10 to bill for services and procedures on and after Oct. 1, 2014 or they will likely see a cash flow interruption, additional costs and delayed claims payments. Time is tight and leveraging payers and vendors for the transition to ICD-10 is a must for practices’ priority “to do” lists.

For many physician practices, preparing for ICD-10 appears like a project bigger than life. It can be tremendously challenging balancing back-office work while delivering excellent patient care with competing mandates and limited resources; I know, I’ve been in private practice. It’s understandable why so many have put off preparing for ICD-10…until now. And since the time to prepare is so compressed, practices are prioritizing their steps over the next few months.

Practitioners must take a step back to identify their practice’s most frequently used codes, review the ICD-10 codes that correspond and understand the documentation needed to support the codes’ expanded descriptions. Do not overlook reaching out to your payers, clearinghouses, vendors and other partners. This is a top priority on which your bottom line depends.

Speak today with your clearinghouse, billing service, PM – whoever your vendors are to be sure you can count on them for support. You’ll want to know you can rely on them for fully operational, upgraded, compliant products and services to be ready in time to allow for thorough ICD-10 testing – or facilitation of testing with your payers; and customer support, training and other resources.

Ask your vendors about how they can ensure your transition will be successful. Confirm their system has been upgraded to Version 5010 standards (this has been required since Jan. 1, 2012) and specifically, ask them about:

• Practice Management system upgrades or replacements for accommodating ICD-10; when they will install; is the upgrade included in your agreement?
• When their upgrades or replacements will be available for testing;
• When they will test with your payers;
• What customer support and training they will provide;
• How they will accommodate both ICD-9 and ICD-10 coded claims since you will have claims for services provided both before and after Oct. 1, 2014.

Speak with payers as you do your vendors. They should be able to provide you with ICD-10 information, tools, resources and services such as testing and perhaps even offer ICD-10 conversion consulting. Ask them about:

• Implementation plans for a successful transition;
• How work flow and business processes might be changing;
• How ICD-10 might impact your contracts;
• Practice support, ICD-10 communications, education and tools;
• When you’ll be able to test with them – confirm a testing date.

Testing ICD-10 is one of the more critical success factors for you to achieve compliance and manage your risk to revenue interruption. Your payers and vendors should be ready to test with you now. After all, it’s only in their best interest to test ICD-10 transactions with you – it helps them to work out kinks in their systems and to ultimately better serve you.

Florida Blue has been testing with providers and their vendors since last year. Testing details, including a self-service format and clinical dx scenarios by specialty, are available at www.floridablue.com/icd-10. Also located here is an extensive online repository of tools, monthly provider teleconferences and other resources.

While there are certainly costs to the ICD-10 conversion, one advantage of its adoption is better clinical data, thanks to the expansion of codes. Here, we see the real opportunity to raise the bar on public health, preventive care and evolving clinical therapies as we get richer patient data. Ultimately, the benefits will outweigh the costs and our industry – and patients – should be the better for it.