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Are You Ready for ICD-10?

Five strategies to help ensure a smooth transition.

The deadline for ICD-10 Compliance is looming, affecting everything from claims processing, to physicians' workflow, and patients' access to care. Many organizations are now rallying employees and resources in order to make the switch from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures before the implementation date of Oct. 1, 2015.

To make matters worse, the transition is not easy, but rather a major undertaking with nearly 19 times as many procedure codes and almost five times as many diagnosis codes in ICD-10 than in ICD-9. While the ICD-10 switch is definitely necessary, as the outdated and clinically inaccurate ICD-9 has not been updated since its installation in 1979, the ICD-10 stands to enhance the quality of healthcare, improve epidemiological research, and enable physicians to make better clinical decisions. This is dependent, however, on the ability for the healthcare industry to make a smooth and accurate transition to the new ICD-10 coding rules.  

Be ready by Oct. 1, by practicing these five strategies: 

1. Employ Robotic Process Automation
There are 68,000 diagnoses codes and nearly 87,000 procedure codes that must be entered and updated in existing EMR, NDC, medical billing, and claims processing data systems. This would take numerous employees days to complete; however, through a series of human-directed scripts, Robotic Process Automation (RPA) technologies populate the specific fields in existing data systems with the ICD-10 data required. RPA technologies, such as EnableSoft's Foxtrot, not only migrate data faster, but precisely. When relying on humans to perform manual data entry, there is a possibility of error, due to mistypes or fatigue. The already costly transition to the new ICD-10 can be mitigated by not having to outsource or hire new employees to manually enter data updates. Furthermore, the data transition can take place over the course of a few days, not a few months, ensuring healthcare providers will be ready to transition to using the new ICD-10 codes by the deadline.

2. Test Your Software  

SEE ALSO: Physician Preparedness for ICD-10

Robust end-to-end testing must occur with your software in order to ensure claims are being accepted properly and processed by insurance contractors, Medicaid, Medicare, and other payment processes are operational. Test internally to ensure transactions can be generated and sent with the ICD-10 codes and test externally to ensure the transactions are successfully received by payment providers and the payment is processed correctly. After Oct. 1, any ICD-9 codes used in transactions will not be accepted for services and rejected for payment. Failure to test your software properly can result in disruptions in patients' receiving the treatment they need and receipt of due payments. 

Are You Ready for ICD-10?3. Educate Your Staff  
The updated, clinically accurate medical coding that is to enhance patient diagnoses, treatment, and billing will not prove capable of these abilities without humans to employ its codes, terminology, and procedures appropriately and correctly. You must educate your staff about the changes to the ICD-10 and perform practices and routines in order to prepare for the change. Have each of your staff participate in educational seminars in order to become informed of the changes and how that will affect their position. Assist and inform staff by identifying the 50-100 most commonly used ICD-9-CM diagnosis codes based on specialties and determine the equivalent ICD-10-CM codes, and have this information accessible to all employees before and after the ICD-10 update. Having your staff prepared and knowledgeable about the ICD-10 will reduce delays in patient care and procedures.  

"The outdated and clinically inaccurate ICD-9 has not been updated since 1979."

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4. Communicate Effectively & Resolve Conflicts
While making the data transition to the new and diverse ICD-10 medical coding, it is imminent that there will be delays in processes, confusion over coding and form completion, as well as workflow changes. Ensure your employees know who they can call on if they are unsure of what code to report, how to complete a form, or other transitory questions that may arise following the ICD-10 implementation. Identify leads and supervisors for each workflow and specialty area that will be available for their staff requests and questions, and make sure those individuals are highly educated on the ICD-10 and have the authority to execute a resolution. Additionally, determine how transactions handled just prior to the compliance date will be managed in order to ensure payment processing will occur-and more importantly-patients are covered financially and receive the best treatment. Identify critical areas or procedures that may be challenging during the transition and have practical resolutions for those practices ready to be executed if, and when, needed.

5. Update Your Forms to Support ICD-10
Patient intake forms, EMR forms, insurance forms, and superbills must be updated to support the ICD-10 codes in order to have patient medical records completed correctly, treatments performed effectively, and payments received. Physician forms must be updated with the new medical terminology and diagnoses and procedural codes, along with superbills. Identify categories of uncommon services and diagnoses and determine units, time, and cost for each category in order for physicians to be able to report in the EMR and on superbills. Determine and have readily available a list of common or most frequently used abbreviations corresponding to the ICD-10 terminology and codes. Lastly, and this goes without saying, obtain the updated and correct documentation that will stand as educational and reference material in regards to the ICD-10. The American Medical Association publishes the ICD-10 codebook and other supplementary educational documentation. Make sure to have these ICD-10 Bibles available, and in all areas, for staff and physicians to reference when needed or desired.

Necessary Disruption
The healthcare industry is about to embark on an intense change in treatment, reporting, and payment processes as the ICD-10 Compliance date approaches. While the ICD-10 is definitely necessary to reflect advances in medicine and detailed diagnoses, the change is extremely disruptive for healthcare providers. By employing efficient technologies and engaging effective strategies, healthcare providers can execute the ICD-10 transition quickly and accurately by the compliance date.   

Richard Milam, is CEO of EnableSoft, an early innovator in the Robotic Process Automation space based in Orlando, Fla.

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