Barriers to Implementing ICD-10

Small to Medium practices face several barriers in the implementation to ICD-10. These include limited funds for implementation, limited internal expertise in ICD-10, significant operational impact from decreased cash-flow, and limited resources to address the onslaught of regulatory changes in the healthcare industry. And, in case you were wondering there are no exceptions granted to small offices for regulatory compliance issues due to small organizational size, lack of funding or lack of staffing!


So what are the steps for dealing with ICD-10 and overcoming or preventing operational disruptions?

 

1. Understand the impact of not preparing for ICD-10 on your practice.

  • Severe disruption of your revenue cycle
  • Increasing days in AR
  • Reduced productivity of all staff
  • Patient frustration over delays in billing

2. Identify the key players for success.

  • Billing software or service
  • EHR vendor
  • Clearinghouse
  • Staff

3. Take action now to prepare for the change

  • Create your plan for implementation

OR

  • Identify a third-party with resources and the ability to assist you with your ICD-10 coding, training and implementation needs.

Cornerstone Medical Management has developed a project plan for small to mid-sized practices to guide you through the transition to ICD-10. Our program is a 12-month, web-based, personally guided ICD-10 implementation plan that supports you throughout all of 2015. We begin in January with a Launch theme and continue working with your office each month providing you a monthly project plan with tasks, training and monitoring to help assure that your office is prepared for this significant change. Click here for details

Over our 15 years in the healthcare industry, we have worked with hundreds of offices across the country on billing, coding and compliance topics. We have the expertise and knowledge to guide your office as you face the unique challenges of implementing ICD-10. Having a project partner to ensure your practice is ready to meet the challenges you will face, may be the key to a successful future. Partner with us and we will provide the planning, execution and training required for a smooth transition.

 

For those that elect to create their own project plan, we offer a series of 10 webinars and 2 classroom training sessions along with a clinical documentation improvement program to support you. These 10 webinars break down the ICD-10 training into manageable pieces. Check out the topics and schedule here.

Now is the time to begin your preparations for ICD-10. The change is substantial and the impact to each office significant.

Your homework for this month is to find a web or classroom based introduction to ICD-10. Cornerstone offers a free one-hour webinar to get you started. For information, click here.

Get acquainted with ICD-10!

The New Language of Healthcare

 

In just under a year we are scheduled to Implement ICD-10 for all HIPAA covered transactions.  This is a significant change in how healthcare business is conducted – but it is not an insurmountable change.  With a bit of forethought, planning and education we can make the transition to ICD-10 less painful.  In the coming months you’ll find tips and tasks to keep you focused on the transition.  After all, you can only eat an elephant one bite at a time!

 

Learning a New Language

 

On October 1, 2015 the language of healthcare is changing.  This new “language” allows providers, payers and others to get a better picture of the patient and far more detail regarding the reason(s) for their visit.

 

Learning a new language takes time.  Communication between doctor and patient isn’t impacted by the change.  You’ll still take care of your patients with the same processes, procedures and care that you do today.  The change comes in communicating with third-party payors.  ICD-10 allows providers to paint a more thorough picture of the patient, allowing the insurance companies to “see” things that they can’t with ICD-9.  This change in communication impacts the inside of healthcare; insurance companies, software vendors, hospitals and doctors.  These new codes provide a more accurate description of the conditions encountered. 

 

Over the next 11 months we’ll work to keep the information we provide simple, clear and useful.  We’ll work to walk you thru how to prepare for the transition, how to speak this new language and how to find the information you need to keep your practice strong.

 

Your task this month is to purchase an ICD-10 book and read the introduction.  It’s important that you have access to this information.  We’ll explore the transition together over the coming months.

ABN forms and Medicare Advantage Plans

Many Medicare Advantage (Part C) plans had developed their own ABN-like forms to assist members in identifying non-covered service.  These forms were required by the Advantage plans if a provider intended to collect from the patient for these non-covered services.

Medicare's ABN rules clearly state that the ABN form cannot be used under Medicare Part C. Medicare put these plans on notice – the rules for Part C are different than Part B – and the ABN form is not to be used.

United Healthcare has issued the following statement:  Effective Dec. 1, 2014, the Protocol to follow to bill a Medicare Advantage member for non-covered services is:

  • Member Consent: Although you can no longer use the ANN Form referenced in the Protocol, you must continue to obtain the Medicare Advantage member’s written consent to seek and collect payment from the member for non-covered services, prior to rendering the non-covered service.
  • Pre-Service Organization Determination: If you know or have reason to know that a service that you are providing or referring for is not covered, you must request a pre-service organization determination for the service from UnitedHealthcare in order to bill the member for that service. UnitedHealthcare must issue a determination before you render or refer for the non-covered service. Please note that a pre-service organization determination is not required to bill a member where the member’s Evidence of Coverage (EOC) or other related materials are clear that a service is never covered.  

Please check out UnitedHealthcareOnline.com for further details.

Other Medicare Advantage Plans may have similar announcements.