April ICD-10 Action Items
by Leigh-Ann Renz, 4.13.15
Meeting ICD-10 Compliance for Mental / Behavioral Health, Psychiatry and Substance Usage
April Item #1: Schedule Testing with Your Payers
Ultimately, the success of ICD-10 depends on the exchange of information between practices and payers: will organizations submit their claims correctly – and will payers process and reimburse ICD-10 claims? To that end, the single most important thing you can do to ensure practice viability during the ICD-10 transition is to be in close communication with your payers and follow their ICD-10 directives.
When will they be ICD-10 ready? Are they offering webinars or trainings about ICD-10? When do they want you to start testing? Will they require dual coding – and if so, when? Contact each of your payers and nail down these details, even if it means that you will be on multiple timelines for claims for a while. Start testing with each payer as early as possible, to ensure that both sides have plenty of time to work out any kinks before the 10.1.15 deadline.
By contacting your payers, you may also gain some educational resource materials for your practice. Many clearinghouses are offering free training webinars with valuable information, and some of them even have ICD-9 to ICD-10 conversion tools available on their websites. Once you know what your payers expect and how they might be able to assist you in the process, the easier it will be to create and implement a plan for your agency.
April Item #2: Update Your Practice
Have a meeting with everyone in your agency, now. Even if you don’t have all of the details nailed down or aren’t sure how it will all play out, make sure that your employees understand that ICD-10 is a huge deal, it will impact reimbursements significantly, and everyone needs to be ready to assist during this transition.
The key points to emphasize are:
- The burden falls to the providers, especially for mental & behavioral health: it is the diagnosis codes that are changing, not CPT codes – and therefore the providers have to significantly change their diagnosis methods. It can’t be left to the Billing Team!
- It’s a big deal. Even though mental / behavioral health is only a small percentage of the 11,000 ICD-9 codes that will become 68,000 ICD-10 codes, payers will be maxed to capacity processing this volume of conversions. Experts are predicting that practices need to have at least six months’ financial reserves in order to weather this storm! It is a big deal and not something that can be left to the last minute. Detailed preparation and testing are essential.
- DSM codes are ICD codes! We’ve heard time and again from mental & behavioral health care providers “I don’t need to worry about ICD-10, because I diagnose with DSM”. The DSM is simply a guide to picking the right ICD code! All claims with dates of service 10.1.15 and after must be coded in ICD-10. The good news is that the DSM-5 provides both ICD-9 and ICD-10 codes, making the transition for mental / behavioral health infinitely easier than general medicine. Make sure your providers are using DSM-5 now to assist with the ICD-10 change-over. Click here for details.
- Everyone needs to help. Remember the 5010 debacle? For many practices, it was an all-hands-on-deck situation to get billing back on track and revenue flowing smoothly again. ICD-10 is expected to be bigger and badder – and all employees should assist in the process.
Have everyone keep their eyes & ears open to feedback from other agencies, resources available through professional organizations, and ideas on how to proceed. Plan on holding monthly ICD-10 meetings with your staff to keep them in the loop. Make sure everyone understands that they may be called on for extra help, if needed, during this process.
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(Disclaimer: Ultimately, it is the responsibility of each practice to ensure coding compliance. PIMSY EMR/SMIS has gathered information from various resources believed to be authorities in their field. However, neither PIMSY EMR/SMIS – nor its employees – nor the authors – warrant that the information is in every respect accurate and/or complete. PIMSY EMR/SMIS assumes no responsibility for use of the information provided. Neither PIMSY EMR/SMIS – nor its employees – nor the authors – shall be responsible for, and expressly disclaim liability for, damages of any kind arising out of the use of, reference to, or reliance on, the content of these educational materials. These materials are for informational purposes only. PIMSY EMR/SMIS does not provide medical, legal, financial or other professional advice and readers are encouraged to consult a professional advisor for such advice.)