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Revenue Cycle Matters - Insights & Tips to Improve Healthcare Collections

3 Tips to Prepare for ICD-10 Right Now

October 05, 2015

Past delays have left Providers wary of the impending ICD-10 transition date, currently set as October 1, 2015. Some groups are pushing for a delay, some are not. Some groups are ready; others are still compiling resources to prepare their staff. No matter the stance or preparedness, all providers seem to have one thought in common - the uncertainty of the ICD-10 deadline.

However, with the recent passing of the Medicare reform package (SRG bill) that made no mention of an ICD-10 delay, most organizations closely following ICD-10 believe the October 1 transition date will stand firm.  At this stage, providers should actively test with their vendors and major payers and ensure contingency plans are in place.

According to an ICD-10 Readiness Survey published by The Workgroup for Electronic Data Interchange (WEDI) in February, of 796 health care providers responding approximately half of hospitals and 10% or physician practices reported testing efforts have begun. About 60% of 173 vendors responding indicated products are available and ready for testing.

OS inc. President Lori Zindl attended ICD-10 sessions at the HIMSS 2015 Conference in Chicago, IL in April. "I find it interesting that there was limited attention to ICD-10 at the conference this year," she says.  "In 2014, ICD-10 was the hot topic at the conference, but the delay was announced shortly after.  My hope is the reduced emphasis on ICD-10 this year is because the healthcare community has taken advantage of the delay to be better prepared for the change rather than apathy because they expect further delay."

Zindl offers her top three tips for ICD-10 preparation right now:

  • Test, test and test.  Test with as many payers as possible - most certainly the payers that make up 80% of your payer mix.  Test direct or through your clearinghouse and perform end-to-end testing, comparing remittance data from ICD-9 to ICD-10 to ensure proper reimbursement, not just confirming ICD-10 file structure.
  • Identify risky payers. Any major payer that is unable or unwilling to do end-to-end testing by July should be considered a risk.  Contingency plans should be made with this payer, including interim payments if necessary, in the event your claims cannot be processed as of October 1.
  • Expect delays. No matter the amount of testing and planning, there will be cash flow delays with the ICD-10 transition.  Discharge-to-bill times will increase with the significant documentation and coding requirements.  Once billed, expect an increase in payment turnaround as well as denials and claim processing issues.  Experts recommend 6-8 months of cash on hand available for the ICD-10 transition.  

Zindl is part of the Wisconsin Hospital Association ICD-10 Task Force, helping providers manage the upcoming ICD-10 changes and associated effects.