Preparing and Training for ICD-10
While all stakeholders will require a significant amount of preparation, some will require in-depth training. Let’s take a look some important preparation considerations by role. Note that this is not a comprehensive list of everything your team will need to do to prepare, but a quick look at some high-priority items your team should have on their radar.
In our white paper, "Planning for the ICD-10 Transition: Getting Your Bearings," we suggested that you consider making your office manager the ICD-10 transition project manager. Whether or not that’s the case in your practice, here are a few important considerations office managers should keep in mind while preparing for the transition.
Maintaining cash flow
Moving to ICD-10 will likely have some negative affect on your bottom line. You can mitigate a lot of this effect with proper training, but even then, you won’t be immune to a cash flow problem. Here are a few tips to help you weather the transition:
- Set up a solid financial plan upfront. This plan should include budgeting for potential cash flow impacts and preparing for delayed claims payments.
- Aggressively manage inventory levels to avoid expensive overstock costs.
- Reduce other administrative overhead where possible, but make sure you have the staff available to handle increased work volume.
- Establish a line of credit, just in case.
Updating policies and procedures
Review your current policies and procedures and update them for the change in workflow and requirements for ICD-10 coding. Make sure everyone on your team is aware of the change in policies and procedures that affect their duties. Here are some examples of changes you might need to make:
- Coding procedure changes – As providers and coders make the transition to ICD-10, their documentation/coding workflows will change change. For instance, if you’re using an ICD-10 code lookup tool to assist with code conversion, you’ll need to update your procedures to reflect this new step.
- Claim rejection auditing – Billers might be responsible for auditing the use of ICD-10 codes and any rejections received by payers as a result of those codes. This type of auditing should be included in the biller’s policies.
Note that this review is a great opportunity for office managers to review all policies and procedures (not just those impacted by ICD-10).
Ensuring proper staff training
The Centers for Medicare and Medicaid Services (CMS) has estimated that ICD-10-CM training for clinical staff and providers will require 8 to 16 hours, 24 to 40 hours for coders, and 4 to 8 hours for IT staff members. Make sure your staff clearly understands the relationships between ICD-9, ICD-10, coding errors / slowdowns and revenue – take advantage of webinars, white papers, and other information offered by CMS to inform your staff of the upcoming changes.
The code set for ICD-10 is significantly larger than the one for ICD-9, increasing from 17,000 to more than 140,000 codes. This will keep your coders busy. The Centers for Medicare and Medicaid Services (CMS) advises that coder education - as well as physician and staff education - begin no later than six months before the compliance deadline.
How long training takes will depend on the individual coder and practice, but CMS estimates about 16 hours for outpatient coders, in part because they will need to learn ICD-10 diagnosis coding only. Coders in hospitals who need to learn inpatient procedure coding will require significantly more time.
The basic look and style of the codes has also changed. Consider this information from the American Medical Association:
With ICD-9, codes were between three and five characters in length. For ICD-10, that number has increased to between three and seven characters. ICD-9 codes also had a set alpha-numeric style: The first character could be alpha or numeric, and characters two through five were strictly numeric. With ICD-10, the first character is always alpha, characters two and three are always numeric, and characters four through seven can be either alpha or numeric. ICD-9 didn't let doctors record laterality, but ICD-10 does. Small changes like this make a significant difference.
Another point that coders should keep in mind is that ICD-10 also has room for new codes. While ICD-9 is inextensible, the new code set allows for greater flexibility - and there may be more to learn down the road.
Because of the greater specificity, both in codes and physician documentation, it's advisable that coders not only study the new set but also refresh their clinical knowledge. This means returning to anatomy and physiology, as well as brushing up on general medical terminology.
Concurrent use (Dual coding)
Many coders will begin using ICD-10 codes while still coding in ICD-9. This is called dual coding, and while it may result in a slightly slower pace, it will ensure that coding is accurate when it reaches payers. The most useful part of dual coding, however, is that alongside the accuracy, coders are getting hands-on experience with ICD-10.
Contact outside vendors and partners
Billers should contact their software vendors, clearinghouses, and payers to ask about their ICD10 transition plan of action and when testing will begin. When e-claims changed from 4010 to 5010 standards, many billers assumed that payers would be able to handle the receipt and processing of 5010 claims. This did not happen as many payers were unable to accept the 5010 format and billers had to work with the software vendors to continue to submit claims to those payers with 4010 standards. To avoid similar confusion, billers should be asking vendors and partners for frequent updates on testing and implementation dates. Additionally, they should ask how the vendor is going to handle crossover coding from ICD-9 to ICD-10.
Become familiar with new codes
Billers should also become familiar with ICD10 code sets for the specialty they bill for. Many medical societies are publishing crosswalk guides to assist with the conversion of ICD9 to ICD10. Billers will likely be called upon by the providers they bill for to offer assistance with ICD10 coding.
Conduct claims tests
When billers know their test dates, they should begin conducting tests with their medical billing software to ensure claims are being successfully processed and received by payers. By practicing with the new system, billers will become more familiar with the ICD-10 process, which will contribute to flawless revenue cycle management.
The first piece of advice for providers in private practice is to ensure that coders have everything they need. Skilled and educated coders will be hard to come by as the ICD-10 deadline nears, making them a valuable asset. For providers, the most apparent change brought on by ICD-10 will be with clinical documentation; but they’ll also need to familiarize themselves with the code set.
Just like ICD-9, the new code set's claims will be based on medical record documentation. In many cases, as CMS has noted, all the information required for accurate ICD-10 coding documentation is already included in patient medical records - but most of it isn't needed for ICD-9. Still, physicians should remain vigilant and ensure that all documentation remains at a high level of specificity. In the event of a non-specific diagnosis, there are still ICD-10 codes available. Some of the most significant changes will be requirements for laterality - which side of the body an injury or illness affects - stages of healing, weeks in pregnancy, episodes of care and others.
Although physicians won't be entering the codes themselves, they should still be familiar with the new code set. Not only will physicians benefit from a greater overall knowledge of ICD-10, but learning about the new codes will help them improve elements of their documentation.
One of the most convincing arguments for physicians to learn about ICD-10 is to keep coders from referring back to physicians, requesting more clarification on documentation. While this is inevitable during training, the less it happens, the fewer stalls in productivity - leading to a smoother workflow. More importantly, doctors don't want to see a loss in revenue. Familiarity with ICD-10 codes will not only boost documentation habits and thus boost revenue, but also help avoid productivity slumps.
How to review
Physicians should start reviewing ICD-10 codes within their specialty. Doctors can seek out what their top diagnoses are with ICD-9 and familiarize themselves with their equivalents or branching diagnoses in ICD-10. When it comes to specialties, there are a number of web resources providing training tools. Medical societies are especially useful. Additionally, CMS has a wealth of training modules and resources available for physicians.
Whatever you do, don't forget to make sure that your vendors are up to date on your training plan, and that they are trained to use ICD-10 as well. Points to talk about include required system upgrades, updated customer support, the ability to accommodate both ICD-9 and ICD-10 during the transition, testing timelines, and implementation dates. For more information on assessing vendor readiness, check out our blog post, Working with Your Vendor Through the ICD-10 Transition.
Everyone's schedule is busy. Really busy. As tough as it can be to cram several hours of preparation and training into those schedules, it’s worth it! Your practice’s ability to maintain cash flow and provide outstanding service to your patients relies on your staff being properly trained. That said, the success of your training plan will depend on your project manager’s ability to get training dates in the books, and make sure all team members are doing their part to be prepared. We recommend you create a written plan for each member of your team, review the plan with them, and check in periodically to make sure things are moving forward.
When designing a training plan, it's important to keep in mind who needs training, how much training they need, and when they are available to take courses. Per CMS' recommendation, those who will be involved in the testing process should already be training. If you’re not, start today! Others who will use ICD-10 after the testing phase need to be trained within six to nine months of the October 2015 deadline.