Editor's Note

Taking ICD-10 Action

Providers cannot delay this critical action item any longer. Fortunately, there's help.

• By David Kopf
• Aug 01, 2015

Death by paper cut — that’s how it can feel having to adhere to a constantly shifting regulatory landscape. Providers must constantly understand and comply with an ever-growing and ever-changing mass of CMS requirements in order to continue billing Medicare with any expectation of reimbursement.

The most pertinent of those requirements today should be ICD-10, but many providers don’t even know what it is. ICD-10 represents the 10th revision of the World Health Organization’s International Classification of Diseases. ICD codes are the basis of classifying diseases, injuries, health encounters and inpatient procedures. ICD-10 is a huge revision, taking ICD-9 from 3,824 procedure codes and 14,025 diagnosis codes to 71,924 procedure codes and 69,823 diagnosis codes.

More to the point, by Oct. 1, your business must comply with ICD-10 if it wants to keep billing Medicare. This is long overdue. The United States has used ICD-9 since 1979, but the World Health Organization completed work on ICD-10 in 1992. Since then 110 nations have been using the unmodified the system, and 25 countries are using a modified version of ICD-10.

Using the legacy coding system of ICD-9 for so long is problematic. It is no longer clinically accurate, and has limited data about patients’ medical conditions and hospital inpatient procedures. Meanwhile ICD-10 enables more detailed patient history coding to help better coordinate a patient’s care across providers and over time. ICD-10 also aims to improve quality measurement and reporting; facilitate the detection and prevention of fraud, waste and abuse; and improve reimbursement accuracy.

Now CMS — and U.S. healthcare with it — is finally catching up with the world. The Department of Health and Human Services issued a hard-andfast rule finalizing Oct. 1 as the new compliance date by which healthcare providers, health plans, and clearinghouses must transition to ICD-10.

The problem is that not enough providers are aware of the deadline. Case in point: we recently asked our online readers how their ICD-10 preparations were going in anticipation of the Oct. 1. Of the respondents, only 18 percent said they were compliant; 36 percent said they would be complaint by Oct. 1; 27 percent said they hadn’t started working on it; and 18 percent said they didn’t even know what ICD-10 was. That was pretty startling.

Worse yet, in discussing the survey results with various industry experts on the subject of ICD-10, I was told on more than one occasion that my results were too positive in comparison to their experience working with providers. Most said they suspected a higher percentage of providers are either unaware of ICD-10 or CMS’s deadline, or aware, but not yet working on compliance.

And that’s critical, because preparing for ICD-10 is not like throwing a switch. Come Oct. 1, your billing software provider is not going to send you an upgrade or a patch that will instantly make all your billing processes ICD-10 compliant. Complying with ICD-10 requires a considerable amount of actual, hands-on work, as well as a good deal of coordination with your referral partners and funding sources.

So how can HMEB help? In addition to past articles on our website, this publication worked with HME software company Brightree LLC to host a free webinar last month on ICD-10 compliance. Hundreds of providers logged on to watch “Your ICD-10 Preparedness Plan,” hosted by Steve Rogers, Brightree’s vice president of product management, who delivered a highly detailed presentation, and answered dozens of provider questions. I strongly encourage any providers trying to jumpstart their ICD-10 compliance efforts to check out the free archive of this webinar by visiting bit.ly/icd-10prep. CMS’s deadline is fast approaching, but this presentation will help you take action.

This article originally appeared in the August 2015 issue of HME Business.