Medicare Compliance & Reimbursement

Office workflow changes, updating claims formatting only tip of the iceberg.

With the start date for ICD-10 set for Oct. 1, 2015, you should have already been making strides towards the transition. But keep in mind that only Medicare definitely requires the transition — you might need to continue to use ICD-9 codes for private payer secondary insurance.

The facts: You’re looking at an upgrade from roughly 14,000 diagnosis codes to 68,000.

“That [in itself] increases implementation costs and possibilities for errors,” says Yuval Lirov, CEO of Vericle, a cloud-based software. You’re looking at office workflow changes, adding to implementation costs and even taking away time from patient care, and reducing cash flow, he says. Not to mention, you have to take care of the basic tasks, such as updating your claims formatting and getting on the same page as your software vendors and billing services.

Beware This Hidden Trap

The Oct. 1, 2015, deadline is for Medicare only, so you can’t give ICD-9 a clean break. “Your local Medicaid, Worker’s Comp, and other payers are under no such compulsion to adopt ICD-10 on the date Medicare does,” says Keddrick Stuart of physical therapy software company Clinicient in Portland, Ore. “You have to be prepared to know which payers have already adopted ICD-10 and which payers are on ICD-9.”

It’s an “unfair payer advantage,” Lirov says. “You have flexible deadlines for payers and a hard deadline for providers, and the providers must be able to handle both ICD-9 and ICD-10 simultaneously.”

Experts hope that with the deadline extended to 2015, most payers will be ready by that point, but providers should be prepared to juggle both code sets for a while just in case.

What You Can Do Now

Having software with ICD-10 codes built in is a ticket to a much smoother transition, some say. If you have software, though, that doesn’t mean you’re in the clear. Be sure to put the following four items on your checklist, according to Lirov:

1. Use an updated system, so your workflow doesn’t change.
2. Make sure all 68,000 ICD-10 draft codes are loaded.
3. Make sure you have a loaded crosswalk of ICD-9 to ICD-10.
4. Enable payer discrimination between ICD-9 and ICD-10.

Payer discrimination functionality should include: a claim format that supports both versions simultaneously, the ability to automatically select ICD-9 or ICD-10 based on payer, ensuring the system prompts you to submit the correct version, and ensuring the system updates as payers announce their readiness.