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ICD-10 checklist: AHA releases step-by-step preparation guide

A new checklist by the American Hospital Association is aimed at ensuring hospitals, and more urgently, physicians, are ready.

Susan Morse, Senior Editor

Illustration of an ICD-10 code (HIMSS)Illustration of an ICD-10 code (HIMSS)

A new checklist by the American Hospital Association is aimed at ensuring hospitals, and more urgently, physicians, are ready for a successful transition to ICD-10 on October 1.

Up to half of physicians report not being ready and a quarter say they are unsure whether they will be, according to an Aug. 3 survey by Workgroup for Electronic Data Interchange.

This compares to three-quarters of hospitals reporting being ready for the new codes under ICD-10.

Lack of readiness may lead to a disruption in claims processing, according to Jim Daley, co-chair of the ICD-10 workgroup for WEDI. Disruptions translate to a payment lag.

The Centers for Medicare and Medicaid Services will also be addressing issues during a Thursday, Aug. 27 national providers' call.

[Also: CMS to hold ICD-10 call for providers on August 27]

Here's the AHA checklist:

  • Verify whether systems and applications within the organization, including vendor software updates, are ready for ICD-10.
  • Evaluate staff training to ensure that all coders, clinicians and other staff who need to be trained are ready.
  • Evaluate documentation improvement efforts, including tools to assist physicians and others in preparing supportive documentation.
  • Ensure the coding team can access ICD-10 coding guidelines and AHA Central Office advice. www.ahacentraloffice.org.
  • Evaluate staffing, the need for additional staff, and overtime, for the transition.
  • Evaluate whether coding productivity will drop, and by how much.
  • Verify external partner readiness to ensure health plans are ready for ICD-10, and establish communication plans and policies with the organizations.
  • Collect emergency contact information for the Medicare contractor and commercial insurers in case claims are delayed.
  • Make sure you know major trading partners' rules and process for submitting replacement claims if you identify a coding problem that should be corrected.
  • Check with major trading partners for workers compensation, automobile insurance or other liability carriers that are not covered by HIPAA to ensure they will be transitioning to ICD-10.
  • Make sure you understand the steps needed to limit delays in payment from these payers.
  • Consider financial protections by establishing metrics that track current claims volume along with associated monetary amounts to create a baseline for tracking future claims volume submitted and processed.
  • Beginning Oct. 1, monitor the status of submitted claims to learn whether problems are occurring so they do not turn into financial hardships. Claim status inquiries are available from health plans through their web portal or through health plan utilization of the HIPAA transaction standard for claim status.
  • Take the time now to learn the policies and processes of trading partners regarding advance payments if you experience payment delays. CMS has procedures that providers can follow for payment advances from Medicare in the event of financial difficulties due to a lag in Medicare billing and/or payments.
  • Consider establishing credit lines that can be used if processing delays adversely affect the normal revenue cycle.

Twitter: @SusanMorseHFN

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