ICD-10 Checklist Created for Hospitals

Rich Daly | August 19, 2015

A RECENT SURVEY INDICATES A MAJOR LAG IN PHYSICIAN PREPARATION AS VARIOUS ORGANIZATIONS UNDERSCORE AVAILABLE HELP.

Aug. 19—A new ICD-10 preparation tool may help the 10 percent of hospitals that recently indicated they may not be ready for the Oct. 1 switch to the new code sets.

The American Hospital Association (AHA) checklist—reported by AHA News–identifies the areas of internal and external readiness hospitals should examine as the deadline to switch to the new code sets approaches. The checklist also identifies financial protections hospitals should review, including the creation of metrics to track the volume of claims submitted and processed.

The AHA checklist followed the release of ICD-10 guidelines from the Centers for Medicare & Medicaid Services (CMS) for clinicians in certain medical specialties. CMS wrote physicians on July 7 to urge them to prepare for the transition and to notify them about first-year flexibility the agency added in recent rules. The agency then issued a FAQ clarifying its guidance and underscoring that there has been no delay “in the implementation of the ICD-10 code set requirement for Medicare or any other organization.”

On Oct. 1, the agency is requiring all HIPAA-compliant providers to switch to the new codes when billing Medicare or Medicaid, and many private payers also will require the switch.

As another way to address concerns that many small-practice physicians lack the resources to accurately use the new billing codes, CMS launched an ICD-10 clinical concepts series for specialties. Clinical concepts for cardiology, which highlight ICD-10 concepts for conditions such as heart failure, hypertension, and heart valve disease, were released Aug. 19.

Readiness Lags
The late readiness push came amid indications that up to half of physicians were in danger of not successfully making the transition. Nearly a quarter of physicians’ offices will not be ready for ICD-10 on Oct. 1, and another quarter are unsure whether they will be ready, according to an Aug. 3 survey by the Workgroup for Electronic Data Interchange (WEDI).

“Without a dedicated and aggressive effort to complete implementation activities in the time remaining, this lack of readiness may lead to disruption in claims processing,” Jim Daley, WEDI past-chair and ICD-10 workgroup co-chair, said in a release.

Other parts of the healthcare industry indicated much greater preparedness. For example about 75 percent of hospitals, health systems, and insurance plans had started or completed external testing. Nearly 90 percent of hospitals and 100 percent of health plans said they would be ready by the compliance date. Additionally, 75 percent of vendors in the survey have completed product development and all expected their products to be ready by Oct. 1.

Other concerns raised by WEDI related to the ICD-10 readiness of state Medicaid agencies. Federal matching funds will not be available to providers who submit Medicaid claims without ICD-10 codes, according to CMS. Only half of the states have confirmed they are ready for the transition to the new code sets, according to published reports.

At least some of the outstanding issues may be addressed during an Aug. 27 national provider call that CMS has announced to address the ICD-10 transition.

Options Highlighted
Amid ongoing legislative maneuvering to either delay the transition or make dual coding available after Oct. 1 for physician practices not ready to support ICD-10, an umbrella group of healthcare organizations recently noted available alternatives.

Among the options for providers concerned they will be unprepared by Oct. 1 is help through outreach programs offered by various private insurers, according to a statement from the Coalition for ICD-10. Additionally, Medicare assistance includes free billing software that can be downloaded from every Medicare administrative contractor. And finally, billing service companies or the Healthcare Billing and Management Association can help providers find a billing service company to assist them with submitting ICD-10-compliant claims.

Source:  HFMA

https://www.hfma.org/Content.aspx?id=40657