You should prepare now for switch to ICD-10
Avoid some very costly problems
Executive Summary
The switch to ICD-10 puts more emphasis on front-end processes, due to more specificity in coding and payer requirements. This expanded role underscores the professionalism required for patient access positions.
-
Managers should watch for an increase in registration errors.
-
Departments should use a variety of modules for training.
-
Patient access employees will need to ask more detailed clinical questions.
The switch to ICD-10 signals a possible turning point for the field of patient access, according to Lisa Gallagher, vice president of technology solutions at the Healthcare Information Management Systems Society.
This code set will replace ICD-9, the current U.S. diagnostic code set, on Oct. 1, 2014. "ICD-10 might be a precipitating factor for a very serious conversation about how the role of patient access is transitioning," says Gallagher. "It's almost as though this is going to force that to happen."
The switch to ICD-10 will put even more emphasis on the front end's collection of information from patients, due to more specificity in coding and payer requirements. (See related story, p. 31, on why patient access staff will need to ask for clinical information.)Sandra J. Wolfskill, FHFMA, director of healthcare finance policy for revenue cycle at the Healthcare Financial Management Association, says patient access managers "need to think about ICD-10 with the same intensity as we would a system conversion."
If patient access areas aren't well-prepared, they will be unable to accurately screen for medical necessity, provide admission notifications, or complete pre-authorizations, warns Wolfskill. "Each of these failures has the same result: rework at some point in the process, and potential delay or loss of reimbursement for services provided," she says. Patient access leaders should consider these actions:
-
Watch for an increase in registration errors of any kind.
"If you start to see some changes in metrics, whatever they might be, you'll need a plan to fix it right away," Gallagher says.
-
Ask yourself, "Which applications that we use every day are going to be affected?"
Wolfskill says your list should include the following applications: scheduling, insurance eligibility and authorization verification, and medical necessity screening.
-
Use a variety of modules for training: classrooms, practice labs, and self-paced Intranet learning. Test competency for each application.
"Details here will make or break the conversion," says Wolfskill. "The learning curve is significant, especially as patient access staff are not full-blown coders." She says training should cover:
-
the basics of ICD-10 and how it differs from ICD-9;
-
most commonly used codes and how to identify other codes as needed;
-
application changes, with an opportunity to practice;
-
how to respond when a provider sends ICD-9 codes instead of the ICD-10 codes.
During the pre-registration process, staff must be sure to select the appropriate ICD-9 or ICD-10 code values based on when services are scheduled to be provided, says Blair Baker, CPAM, director of provider product development for Emdeon, a Nashville, TN-based provider of revenue and payment cycle management solutions.
Services performed on or after Oct. 1, 2014, must be coded using ICD-10, and services prior to Oct. 1 must be coded using ICD-9. "This is important when scheduling procedures and validating medical necessity," says Baker.
-
Use a "just-in-time" approach for staff training.
Wolfskill recommends providing training four to six weeks in advance. This schedule allows staff enough time to practice and fives managers enough time to assess their competency.
"One outcome of the one-year delay in the implementation was to prove that training done well in advance, and then not used, equates to a need to completely retrain physicians and staff," Wolfskill says.
SOURCES/RESOURCE
- Blair Baker, CPAM, Director, Product Development, Emdeon, Nashville, TN. Phone: (615) 932-3245. Email: [email protected].
- Jim Daley, Director, IT Risk & Compliance, BlueCross BlueShield of South Carolina, Columbia. Phone: (803) 264-4449. Email: [email protected].
- Lisa Gallagher, Vice President of Technology Solutions, Healthcare Information Management Systems Society, Chicago. Email: [email protected].
- Sandra J. Wolfskill, FHFMA, Director, Healthcare Finance Policy/Revenue Cycle, Healthcare Financial Management Association, Westchester, IL. Phone: (708) 492-3419. Email: [email protected].
The Centers for Medicare & Medicaid Services has released a video on ICD-10 Coding Basics, which provides a basic introduction to the code set. To access the video on YouTube, go to http://bit.ly/1e83JiO.
