Around this time last year, Congress passed another round of SGR fix legislation. But unlike previous fix bills, this one included language that delayed ICD-10 implementation until 2015. For some people, the extra time offered a major sense of relief. But time flies, and now—whether or not you used that extra time to get your preparatory ducks in a row—the harsh reality is that you’ve only got six months left until implementation D-Day.
The new code set is complex, which has been a huge source of concern for many providers. However, it’s important to understand that this complexity is meant not to stop us dead in our tracks, but to prepare us for future healthcare standards. That might not be enough to change your opinion on the timeline for the switch, but whatever side of the fence you’re on, one thing’s for sure: the change is long overdue. After all, we’re the last major developed country that hasn’t made the jump. And although ICD-10 is undoubtedly one of the biggest changes—and challenges—our industry has ever faced, I believe that with some preparation, we’ll be ready to tackle it head-on come October 1.
Are you ready? Here’s what you should add to your ICD-10 preparatory checklist:
If you and your staff didn’t start training for ICD-10 last year, it’s absolutely crucial that you begin now. Start by researching different training methods. Once you’ve got a good idea of the available options, select and apply the one that works best for you and your staff. One great resource to get you started: ICD-10 for PT. And if you’re an APTA member, you always have access to their vast library of content. Additionally, the WebPT Blog is chock-full of ICD-10 educational resources. If self-education isn’t your bag, participate in some personalized, interactive training from folks like Rick Gawenda of Gawenda Seminars and Consulting and Tom Ambury of the PT Compliance Group. Regardless of what educational approach you take, remember to stay flexible during the training process. You’ll want to train your staff in a way that fosters retention and doesn’t overburden their already jam-packed schedules.
Save money. It’s a basic concept, but your ICD-10 budget and savings plan may not turn out to be that simplistic. First, it’s important to create a budget that accounts for all of your clinic’s ICD-10 transitional needs. This could include anything from the cost of purchasing and implementing new software (e.g., an ICD-10-compliant EMR) to hiring a professional medical coder. In addition to setting aside money for specific needs, experts suggest saving three to six months’ worth of cash revenue to protect against unforeseen transitional hiccups—like reimbursement delays. Saving emergency money is never a bad idea, and if you haven’t already started squirreling away some extra cash, now is a great time to get going.
Are your payers testing ICD-10? Have you looked into Medicare testing opportunities? What about ICD-10 testing within your own clinic? To test with your payers, you’ll need to contact each one directly to determine their testing periods and processes. If possible, you’ll want to submit ICD-10 codes to each of your payers before the October 1 deadline to ensure they’re ready to receive and process the new codes. That, in turn, could help you avoid claim denials in the wake of the transition. If you do test with your payers, be sure to review your results so you can tailor your clinic’s processes accordingly. Medicare has already completed one round of end-to-end testing this year and will conduct further testing in April and July.
The only way you’ll know if your staff, software vendors, and billing systems are ready is—you guessed it—asking. In fact, I’d recommend asking yourself if you’re truly ready for the transition. (How’s that for a reality check?) If you still have a lot of questions, you’re not alone. I recently hosted an ICD-10 webinar for WebPT, and it generated a lot of questions from viewers. Here are a few examples of common inquiries floating around our industry as well as their answers:
Does ICD-10 affect CPT codes?
According to this CMS document for outpatient procedures, the answer is “no.” The CPT coding process will not change as a result of the transition to the new code set.
Will ICD-10 affect the therapy cap and G-codes?
ICD-10 will not affect the therapy cap or G-codes in any way whatsoever.
Do providers use ICD-10 codes based on date of service or claim submission date?
This question has been popping up all over the place, and CMS has made it clear that providers should use ICD-9 codes for all dates of service falling on or before September 30 (regardless of claim submission date). Furthermore, if you need to submit both ICD-9 and ICD-10 codes, you’ll want to submit split claims. If both types of codes appear on the same claim, you could receive a denial.
For the full list of FAQs from the webinar, check out this post.
Sure, you have almost 200 days to get ready for ICD-10, but as history has shown us, those days will be gone before we know it. And with all signs pointing away from any additional delays, it’s important to get going on your preparations sooner rather than later. Do you need help getting started? Check out this webinar for help with crafting your preparation checklist.
About the Author
Heidi Jannenga, PT, MPT, ATC/L, Founder and COO of WebPT
As Chief Operating Officer, Heidi leads the product strategy and oversees the WebPT brand vision. She co-founded WebPT after recognizing the need for a more sophisticated industry-specific EMR platform and has guided the company through exponential growth, while garnering national recognition. Heidi brings with her more than 15 years of experience as a physical therapist and multi-clinic site director as well as a passion for healthcare innovation, entrepreneurship, and leadership.An active member of the sports and private practice sections of the APTA, Heidi advocates for independent small businesses, speaks as a subject matter expert at industry conferences and events, and participates in local and national technology, entrepreneurship, and women-in-leadership seminars. Heidi is a mentor to physical therapy students and local entrepreneurs and leverages her platform to promote the importance of diversity, company culture, and overall business acumen for private practice physical therapy clinics.Heidi was a collegiate basketball player at the University of California, Davis, and remains a life-long fan of the Aggies. She graduated with a BS in Biological Sciences and Exercise Physiology, went on to earn her MPT at the Institute of Physical Therapy in St. Augustine, Florida, and recently obtained her DPT through EIM. When she’s not enjoying time with her daughter Ava, Heidi is perfecting her Spanish, practicing yoga, or hiking one of her favorite Phoenix trails.