With the recent passing of the Medicare and CHIP Reauthorization Act of 2015, a.k.a. the "doc fix," without any language to delay ICD-10, most organizations in the healthcare industry saw this as the green light indicating that the ICD-10 implementation date of Oct. 1, 2015 will not change. However, several congressmen reintroduced a bill dubbed the Cutting Costly Codes Act of 2015 in early May to try to stop the implementation of ICD-10. The bill calls for a "study to identify steps that can be taken to mitigate the disruption on healthcare providers resulting from a replacement of ICD-9." Industry reports suggest the bill has only a 3 percent chance of even making it out of committee, and an even lower chance of passing.
So, what should you do? Do not wait for the outcome on the Cutting Costly Codes Act of 2015. Get on board the ICD-10 train before it runs you over!
If you have not started your implementation processes, you must start immediately. The industry has known that this was coming for several years, and many health systems and insurance companies are on track, putting the final pieces of their three-year plans in place. However, if you have been in denial and are just now starting to get ready for ICD-10, you are very far behind and have a lot of catching up to do in a very short period of time.
Many hospitals are worried about the financial impact of ICD-10. Studies by the Centers for Medicare & Medicaid Services (CMS) have shown that the impact is projected to be statistically, zero (-0.04 percent). However, it is important to understand that the methodology of the study may not yield an accurate reflection of the specific impact to your facility. The case mix used in the study was a combination of the nation's top 25 DRGs. If your case mix differs from this case mix, then the impact may be greater (or smaller!) Additionally, it was found that quality of coding and documentation had a significantly more dramatic projected financial impact on providers than the actual changes between the two coding systems.
As we enter the last few months before implementation, ensure that all staff members who participate in the coding and billing process receive education on the new coding system. Remember that documentation is a key component to correct coding, so be sure to include all clinical staff responsible for documentation in the education process. For physician practices to maximize efficiency, focus documentation and coding education on the codes that will be used by your practice/specialty, and not every code in the book. For coders who have received ICD-10 education, now is the time to start practicing in ICD-10 by coding a percentage of charts in both ICD-9 and ICD-10.
Do not rely on software to do the coding translations for you. Studies have shown that the general equivalency mappings (GEMs) do not accurately translate all codes. Many ICD-9-CM codes are mapped to unspecified codes in ICD-10-CM/PCS, which may result in lower reimbursement and/or rejections of physicians' claims. Practice coding "old school" by using the ICD-10 books. Once you are proficient using the books, then switch to the encoder (software-assisted coding).
The bottom line is that the implementation date of Oct. 1, 2015 is as firm as ever, and now is the time to put the final pieces of your implementation plan in place.
For more information on Panacea's ICD-10 and other HIM services, contact John Anderson at 800-252-1578, Ext. 3425, or register here.