Another ICD-10 “testing week” is coming soon on June 1-5, 2015. Providers will be able to test their processes for ICD-10 with Medicare Administrative Contractors (MACs). Information on how to participate is available on your MAC website or through your clearinghouse. Claims testing is for acknowledgment only and technical support will be provided by CMS. CMS will offer end-to-end testing later in the summer but this is for a limited group of volunteer organizations.
Too often, mid-size practices are left to figure things out for themselves with losses in revenue and staff time just part of the costs they need to cover. Having strong partners and additional perspectives is critical. Networking through the MGMA with other administrators and leveraging your vendor expertise is critical. Having a testing strategy for major industry changes like the ICD-10 transition is imperative. Getting a planning team in place, a budget, training strategy in addition to robust testing is the minimum for this ensuring industry transition goes off well.
As a revenue cycle management company supporting mid-size independent practices across the Midwest, ORI is a key partner for the ICD-10 transition in 2015. Currently, the ORI team is ensuring existing vendors and systems are moving through preparation stages and are following an internal strategy and schedule. A testing and implementation schedule is being developed with clearinghouses and practice management systems which will begin in the 3rd quarter of 2015. For those legacy systems or challenged vendors, ORI has been reviewing options for new systems, software, and vendors. Specifically, by moving to robust practice management systems and clearinghouses with strong service models and open interfacing, the options and flexibility increase exponentially. Moreover, Outsource Receivables has built coding department workflows to support clients through the transition.
ORI is working with clinics in Minnesota, Iowa, and Wisconsin to evaluate multiple areas of their practice and helping them develop a plan of action for testing in 2015. Meetings with clients are being facilitated that dig into the details including:
- Evaluate existing workflow areas impacted by ICD-10
- Gather and review forms impacted by coding changes
- Identify diagnosis based payment contracts
- Identify medical documentation process and requirements for ICD-10
- Review EHR templates for areas of revision
- Address workflow inefficiencies and a plan for process upgrades
- Review the top 100 ICD-9 codes and assign annual dollar value
The areas of medical billing that need testing include provider documentation, coding processes, claims submission, clearinghouse edits, and payers. Each of these requires internal and external discussions and careful planning. Currently, these testing environments may exist in silos. Your physicians may be working on evaluating documentation standards and requirements and your coder is taking ICD-10 training; but have they really sat down to see how roles will impact each other? Likewise, the EMRs are ensuring that the fields and forms support the new code set and the code search tools are already supporting the system; but will they integrate seamlessly to create work flow efficiencies and reduce the time burden on coders and physicians? Practice management systems are also gearing up; but what workflow tools are in place to have confidence that if rejects double or triple, your staff will have a clear process for revising and resubmitting claims? Perhaps the biggest question is what will happen with the claim when going from the clearinghouse to the payer? While this may not be a significant source of revenue, the amount of time to follow-up manual processes will become a bigger and bigger factor as other areas grow in their demand for attention.
The best advice in this situation is to reduce your risk by first concentrating on your primary revenue drivers. ORI has been providing the practices it serves with ICD-9 code sets sorted by use frequency and overall annual charge amounts, as well as cross walking codes to ICD-10. In addition, the most common payers are categorized. Together, they create a priority list and risk assessment for ICD-10 testing. In addition, the list provides a starting point for physician training on specific procedures, potential codes, variables such as laterality, and documentation requirements. This narrows the challenge into manageable portions to bring the task down to size.
There is simply no substitute for testing in a live environment where all of the variables are in place. The challenge with ICD-10 is the inability to run tests with every payer for every possible scenario. There will always be unknowns and this is just the current reality. Testing with a diverse set of payers is the goal, but will largely depend on commercial health plan readiness. This may be the determining factor come October 1st, 2015.
For independent practices, choosing the right partners can make all the difference. ORI approaches the business of revenue cycle management from a collaboration stand point. When ORI’s clinics win, so does ORI. Choose your partners carefully. It’s an important decision and even more important with ICD-10 on the horizon.