To successfully implement ICD-10, you need the right plan, the right solutions, and the best support—and that’s exactly what ZirMed delivers. We provide resources to help you prepare and plan, offer solutions to help you test and transition, and deliver insight to help you take the right steps the first time. Make ICD-10 less daunting—create a plan for success with ZirMed.
Gain an understanding of the regulatory mandate, give your practice decision makers and staff a high-level overview of ICD-10 and get buy-in to begin implementation preparation. Get organized and figure out what you are going to do and how you are going to do it.
Review the new regulations and requirements.
Prepare a high level report for physicians and staff members to inform them of the upcoming changes.
Perform a high-level assessment of how a diagnosis code is utilized in your practice.
Prepare a high-level report for decision makers to describe ICD-10 implementation impact and what action is required to ensure compliance. It should outline the impact on documentation, billing systems, coding systems, IT, and all other areas.
Meet with practice decision makers to obtain buy-in on the urgency of ICD-10 and the need to begin preparing now.
Establish an ICD-10 project team or point person to oversee the transition. This team will be responsible for overseeing the ICD-10 transition, and will vary based on the size of your organization. Larger practices should have a team with representatives from different departments (e.g., executive leadership, physicians, and IT). Smaller practices may only have one or two individuals responsible for helping the practice make the switch to ICD-10.
Develop and complete a Project Plan that meets the physician's practice and staff needs. Identify specific deadlines and person(s) responsible for each subsequent phase. Keep in mind the implementation deadline.
Establish a risk management identification, documentation, mitigation strategies and contingency plan.
Begin communicating with staff and business partners about ICD-10.
The assessment step will identify changes to clinical documentation and medical coding procedures within the clinical practice. You need to really understand where ICD-9 is currently used and where ICD-10 will be used, and what changes in your practice will need to be made. This is where you really try to work out more of the details.
Identify processes and systems which require ICD code inputs, process ICD codes, or produce outputs using ICD codes.
Verify with your staff where codes are used, such as manuals, superbills, practice management software, and billing software
Assess business and policy impacts - Identify clinical and business processes, policies and supporting systems that must be changed to accommodate ICD-10
Assess technological impacts
Evaluate all systems, coding applications, and software to ensure compatibility with ICD-10. Note: Systems must support both ICD-9 and ICD-10 code sets for a period of time.
Conduct a risk analysis and create a remediation strategy.
Evaluate clinical documentation to determine if current specificity allows an ICD-10 code to be assigned.
Assess by disease process, by provider, by specialty, or by group.
Run a report to indicate the most frequently used diagnosis codes within the practice.
Share results of assessment with providers to educate on new specificity requirements of ICD-10.
Identify mission critical vendors and electronic trading partners to ensure that they meet your clinical and administrative functional requirements. Evaluate their offerings and capabilities.
Determine what plans your mission critical vendors have in order to make sure they are in compliance with the regulation and meeting the deadline.
Determine what personnel will need to be trained on the changes.
Assess skill levels/gaps of personnel for future needs and training. Develop a training plan.
Identify and assess readiness of vendors, clearinghouses, and other business associates whose involvement is essential to ICD-10 implementation;
Identify mission critical payers to determine any anticipated changes in reimbursement based on ICD-10 or any anticipated modifications to fee schedules. Make necessary plans and mitigation strategies.
Review contracts and service level agreements to identify any impacts of ICD-10 and make changes as necessary.
Document and communicate impact assessment findings
This step is where you will identify how you are going to go from your current ICD-9 world to the future ICD-10 world in a step-by-step fashion. This phase of implementation involves organization-wide upgrading/changing of business processes, information systems, software applications, health information management systems, education of medical billers and coders, as well as clinical documentation education for medical staff.
Remember, ICD-10’s increased specificity requires more detailed clinical documentation. Clinical Link—ZirMed’s HIPAA-compliant messaging platform—automates task tracking and notes, interoperates with all PM and EHR systems, and more. To learn more, visit public.zirmed.com/solutions-overview/clinical-link.
Create a budget.
Figure out how much the ICD-10 transition will cost, this should be comprehensive and include all costs from planning phase to final transition.
Consider software & hardware, training and education, testing, staff etc.
Secure funding for the project.
Identify system migration strategies
Implement issue tracking with mitigation strategies.
Work with vendors to schedule timeframes for practice management/EMR/coding systems upgrades, testing and integration.
Upgrade systems: Implement business processes, information systems, software applications and technical modifications
Work with vendor or develop plan to address claims incurred with dates of service before 10/1/2014 which will be coded with ICD-9 codes and for claims incurred with dates of serviced after 10/1/2014, which need to run concurrently.
Obtain, verify and document that the most recent version of ICD-10 codes have been updated.
Conduct high-level training on ICD-10 for clinicians and coders to prepare for testing (e.g., clinical documentation, software updates)
In-depth training should occur 6-8 months prior to the implementation date.
Identify the level of education needed for each set of staff members: coders, clinicians, physicians and additional staff
Review coder and clinician preparation
Pick best training options
Begin detailed ICD-10 coding training – ICD-10 coding training, procedural training and clinical documentation improvement (CDI) initiatives
Before you implement something, you need to know and make sure that it works. You do this every time you are implementing something new. Test all your business processes and IT systems (internal testing). Test your transactions and medical claims with your Trading Partners (external testing). ICD-10 codes must work in all aspects of your organization.
Create a test plan and test scripts
Use ICD-10 codes for diagnoses your practice sees most often.
Make sure you test using your high volume, high revenue impacted codes
Start testing ICD-10 codes and systems with your practice’s coding, billing, and clinical staff.
Test ICD-10 compliance across internal policies, processes, and systems to ensure compliance.
Re-evaluate clinical documentation for ICD-10 readiness. 90% accuracy is recommended.
Test knowledge of physicians and staff to validate preparedness for ICD-10.
Determine what percentage (%) of mission critical external Trading Partners you will be testing.
Begin testing claims and other transactions using ICD-10 codes with business trading partners such as payers, clearinghouses, and billing services
Complete end-to-end testing with the identified percentage (%) of mission critical external trading partners if available.
How do you actually make the jump and what do you need to look for while you are making that transition? Appoint a Post ICD-10 Committee to review implementation results, evaluate success against established criteria and to identify what works and doesn’t work, especially in revenue cycle, HIM, and IT areas. The Post ICD-10 Committee must quickly identify any issues, establish feedback loops and work the established solution path to completion.
Identify Go-Live tasks and associated actions.
Prepare and establish the production and go-live environments.
Create a back-up plan in the event there is a problem with moving to production.
Develop a plan for post implementation data analysis – focus on identifying high volume code/code categories.
Prepare your practice to take corrective action
Identify Operational impacts and strategy and key transition components with respective action.
Develop post-Implementation audit processes and procedures
Contingency planning – identify what to do if payers aren’t ready or if vendors aren’t ready
Complete ICD-10 transition for full compliance. Upgrades to systems should be pushed live and systems should be turned on in production mode
Begin using both ICD-10 and ICD-9 code sets in tandem.
ICD-9 codes continue to be used for services provided before the deadline and ICD-10 codes required for services provided on or after the deadline.
Make all new policies and procedures effective
Monitor systems and the impact of ICD-10 on your business operations and revenue
Re-evaluate medical record documentation for compliance through readiness assessments. Re-train providers as necessary
Analyze any claim denials and make appropriate adjustments to reduce them
Assess whether new policies are being followed and the effectiveness of each. Compare expectations to actual results.
Monitor and measure coding and billing productivity. Set goals and plan for ongoing training to improve productivity.
Audit systems and software for accuracy.
Analyze all changes and look for gaps between what were expected and actual results to determine areas that need additional adjustments.
Provide additional training as needed in the areas where deficiencies are identified.