The ICD-10 Transition: Getting Your Bearings

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There are two extremely important aspects of your business that the transition to ICD-10 will affect: your revenue cycle, and your ability to provide great healthcare to your patients. You can protect both by planning ahead and making sure everybody involved knows their role.

It requires a lot of work, and it won’t be incredibly easy – but preparing now will save you a lot of headaches leading up to the transition deadline. If you haven’t made much progress yet, no worries, but now’s the time to start.

The ICD-10 transition will affect all of your staff members, and all of their workflows. Let’s consider all of the people who will play a role. For small practices, stakeholders will be providers, billers, coders, office managers, and any outside partners (clearinghouses, labs, software vendors, billing services, etc.). It’s very important that everyone understands how they fit into the big picture. Here’s a high level look at what each role should consider in terms of process and workflow:

To identify all of the details, ask your stakeholders to conduct an "ICD-10 impact assessment" – each member should dissect his/her workflow and identify all areas that currently rely on ICD-9. This process will give your team insight into the type of preparation, training, and testing that will be required to make a smooth transition.

We suggest appointing a project manager to lead your team through the transition. This person will be responsible for running the initiative and making sure all stakeholders know what’s expected of them. The project manager will have to work with individual team members to pinpoint relevant system and workflow changes, the timeline for these changes, and the associated costs.

While you can choose anyone you like, office managers tend to have a knack for rallying the troops and making sure operations go smoothly. The relationships they have with office staff and outside partners can break down communication silos and keep the initiative moving forward.

Here are a few things your project manager should consider from the start:

Facilitating communication!

A successful transition to ICD-10 requires ongoing communication between the project manager, office staff, and outside partners. We can’t stress this enough! As stakeholders juggle all their other tasks and initiatives, plans will shift and issues will pop up. Staying in constant contact will help your team minimize problems with reimbursement and stay focused on providing great health care. It’s the project manager’s job to ensure these communication channels stay open and active – regular project status calls are a great way to make sure this happens.

Budgeting

The transition has a few costs you should be aware of:

  • Training materials, courses, and/or programs. When it comes to training your staff, you’ll have a lot of options, some of which will incur a cost. We talk more about training considerations, costs, and resources, in Training and Preparing Your ICD-10 Stakeholders.
  • Practice management and EHR software costs can range anywhere from $0 to thousands of dollars per year. Note that if you already have a cloud-based PM/EHR solution in place (vs. client/server), it’s unlikely you’ll have to pay anything more to make your system ICD-10 ready.
  • Legal fees necessary to update policy documents or vendor/payer contracts.
  • Cash flow reduction and emergency fund – Even with great training, you can expect operations to slow down following the transition. Coding time, coding backlog, and turnaround time will likely all increase. So play it safe: create an emergency fund to ease your mind as you begin optimize your newly-ICD-10 compliant revenue cycle.

Designing a training plan

Design a training plan for each role or member on your team. ICD-10 affects everybody differently, so training plans will differ accordingly. It’s important to get a head start on training -- things will only get busier as we approach the deadline. Later in this article, we’ll suggest some best practices for making sure each role is prepared.

Updating policies and procedures

Because ICD-10 will affect your entire team and so much of their workflow, you’ll likely have to update policies and procedures that reflect this workflow. As you discuss the transition with your stakeholders, and determine exactly how their workflows will change, necessary policy and procedure updates will start to become apparent. Examples of changes you need to make include claim rejection auditing in billing policies and coding procedure updates.

Assessing partner- and vendor-readiness

From software vendors to clearinghouses to payers: How will they address crossover coding? Will they be able to accept codes by the official deadline? How will they help you test leading up to the transition? We dive a little deeper into this in our blog post Working with Your Vendor Through the ICD-10 Transition.

Testing and going live

Because there are so many moving pieces involved in the transition, it’s incredibly important to run through several real-life scenarios leading up to the transition deadline. Ultimately, you need to test your entire revenue cycle from clinical documentation to ERA. Be sure to schedule your tests far ahead of time; they can’t be an afterthought.

There are a lot of things to do to ensure a seamless transition, and thoughtful scheduling is essential to making them all happen. You’ll have to work through details with vendors, partners, and payers, plan for training your staff, and schedule tests – and make it all jive with everybody’s already-busy schedules. Check out this timeline from CMS to get an idea of where you should be in the process.