It's not too soon to start coordinating with referral partners, planning for the increased workload that will come with ICD-10, and making sure that provisions for dual coding are in place.
This article appears in the July, 2014 issue of Managed Care Contracting and Reimbursement Advisor.
With the ICD-10 transition delayed until October 1, 2015, physicians have more time to assess their switchover programs and look for weak points. Working with referral partners is likely to be a shortcoming for most physician practices, and the ICD-10 delay means you can fix the problem.
Coordinating with referral partners will be especially important for specialists who get their patients from another resource, says David Zetter, founder of Zetter HealthCare in Mechanicsburg, Pennsylvania, and a member of the National Society of Certified Healthcare Business Consultants. He is a certified coder and certified auditor for medical coding.
"Whoever is calling to make that referral or to transfer the care of that patient needs to provide the best diagnosis code," Zetter says. "The best strategy is to determine how each person in your practice now touches ICD-9 codes. The person in your office who is taking that phone call or referral needs to understand what information they need from that referral partner to make sure that diagnosis code is accurate as possible and includes all the information."
The referral partner may not always provide the code; instead, it might provide the definition of the code, Zetter says. That is still workable if the person receiving the information can use the definition to find the proper alphanumeric code, he says. Achieving this information transfer could be accomplished through a form filled out by your referral partners or simply an agreement that the data will be expected when patients are referred by phone, he suggests.
"Not everyone realizes that they have to train people in their practices based on how they used that information," Zetter says. "Even if you're on top of things and training your people for the transition, you need to communicate with referral partners to assure that they are doing the same. It won't work for only one side of the conversation to be ready when ICD-10 comes."
Audit and prioritize referrals
Practices should begin by auditing their referrals to determine exactly where they come from, suggests John Dugan, a partner with the U.S. Healthcare Provider Practice of PricewaterhouseCoopers in Philadelphia and the firm's ICD-10 leader. Organize the referrals according to recording volume, referral value, or both. That will show you which referral partners should be your top priority for ICD-10 coordination, Dugan says.Those partners can be assessed for the current quality of their referral information to ICD-10, he suggests.
"Quite often your referrals are going to be pretty generic, because the reason for the referral often is to get a more specific diagnosis," Dugan explains. "Physicians will have to work with the top leadership at their referral partners to assess how referrals are made now and what gas there may be in the information."
Zetter and Dugan agree that many physician practices are not ready for ICD-10. Larger practices are further along, but smaller practices should seize the opportunity provided by the delay to catch up, Dugan says. Payers may not be much better off, and Zetter suspects that ICD-10 was delayed largely because the payers weren't ready, rather than a lack of preparation on the providers' part.
"In my meetings with the Blues, they indicated that they weren't ready for this, and that was about three months ago," Zetter says. "So if the Blues don't have their entire plans in place, how the heck could we possibly switch?"
In addition, Dugan cautions that physician practices may be underestimating the increased workload that will come with ICD-10. Studies have shown that the new system will take about 30% more staff time, and many practices are preparing to increase staff in response, he says.
Committees Can Help
Formalizing the ICD-10 transition effort will help a physician practice, Dugan says. Rather than assigning the responsibility to one or two people, the practice should form transition committees to address the main tasks that are associated with the switch to ICD-10: education, forms, and communication.
The education committee can take responsibility for training staff, especially coders, and testing their skills before the transition, Dugan explains. The forms committee can take on the task of revising all in-house forms (including the EHR) to comply with ICD-10, and the communication committee can be responsible for ensuring effective communication with referral partners, payers, and hospitals.
Dual coding will become an issue because some payers allow you a long time in which to submit a claim. Medicare allows a year from the date of service, for instance. That means that a claim submitted for service before October 1, 2015, will require an ICD-9 code even though you may submit it in January 2016—but that claim will require the new ICD-10 code as well. That can become a burden for physician practices, Zetter says, particularly if the EHR is not capable of dual coding.
For bills that fall in that overlap time period, the EHR must be able to include both a five-digit code and a seven-digit alphanumeric code. In addition, the clearinghouse and the payer need to be able to handle both codes on the same bill.
"The problem is that some systems use software that is somewhat old and they can't be updated to make dual coding possible, and some can't handle just ICD-10 alone," Zetter says. "Some practices are going to be forced to buy a new processing system that can do ICD-10 coding, and then manage both the old system and the new system simultaneously."
Use Crosswalks Between 9 and 10
Even after the transition, practices will have to keep staff trained on ICD-9 codes, Zetter says. In a gastrology practice, for instance, a recall patient for a colonoscopy may be seen five years after the previous exam. So staff will have to know how to take the old ICD-9 code in the patient record and translate it to the new ICD-10 code for the current care.
To address that need, Zetter recommends physician practices determine their most used ICD-9 codes for the past year and provide office staff a crosswalk between those and the new ICD-10 codes. This can be built into the EHR, if possible, crossmatched with the pull-down menu of frequently used ICD-10 codes.
However, even if a crosswalk can be built into the EHR, Zetter says you still should provide staff a printed resource. "When you have it on paper and you have it organized properly, staff can find the proper ICD-9 code in seconds," he says. "That can be faster than hunting it down in the EHR"