Healthcare Law Blog

Part II: Are U.S. Providers Ready to Catch Up in Medical Coding?

If you are a provider and are unsure about the differences in ICD-9 and ICD-10 codes or why there is a need for implementation, I highly suggest you read Tuesday’s post.

The ICD-10 compliance deadline is approaching and it affects everyone, not just providers who submit Medicare or Medicaid claims. Any entity that is covered by HIPAA, including payers, clearinghouses, and billing services, must make the switch. Organizations that are not covered by HIPAA, but still use medical coding, would be wise to participate as well, because ICD-9 codes will soon be obsolete. For providers, reimbursement claims that do not use ICD-10 codes for diagnosis and inpatient procedure starting October 1, 2014 cannot be processed. This means that you will not get paid, if you continue to use the old ICD-9 codes after October 1, 2014.

The interesting caveat about ICD-10 is that it cannot be used before October 1, 2014. If you were thinking about getting on the train early, think again. Payers will not accept ICD-10 codes before October 1, 2014. Thus, until September 30, 2014, everyone must continue to use ICD-9 codes. But the next day, October 1, 2014, everyone must use ICD-10 codes to get paid.

Providers are just now wrapping their heads around the patient influx and insurance modifications associated with the Health Exchanges, but there is no time to waste in preparing for the next wave of change. Here is what providers should be doing now to make the ICD-10 transition as seamless as possible:

• Appoint an ICD-10 manager or coordinator to lead the transition and become intimately familiar with the new coding.

• Plan for significant training on the new ICD-10 codes and documentation standards.

• Create a timeline for implementation. When will training, system upgrades, or practice run-throughs occur?

• Determine how ICD-10 will affect electronic health records, records, management and billing systems. How will the transition affect work flow or business processes?

• Review contracts with vendors. Is the upgrade or necessary technology covered by the existing contract?

• Review contracts with payers. Payment schedules or reimbursements may need to be altered to reflect the more in-depth coding descriptions.

• Establish the budget needed for the transition. Take into account possible system upgrades or new hardware, training, form revisions, etc.

• Converse with IT, EHR vendors, payers and billing department to ensure that everyone is prepared. Most importantly, conduct test transactions! Practice makes perfect.

October 1, 2013 was not a good day for health care insurance in the United States; the blunders associated with the rollout of the federal and state Health Exchanges created chaos and uncertainty. Start preparing now for the ICD-10 codes so that October 1, 2014 changes can be much smoother. If you would like more information on ICD-10 or any upcoming compliance regulations, contact the health care attorneys at McBrayer today.

Services may be performed by others.

This article does not constitute legal advice.