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ICD-10 Transition Services

The current implementation date for the transition to ICD-10 is October 1, 2015. It appears that there will not be any additional delays and implementation will proceed accordingly. There is still time to plan for your transition though time is of the essence. Oncore Associates provides ICD-10 transition planning and project management.

Some of the services we provide as part of your ICD-10 transition include;

Gap analysis and needs assessment

As part of our engagement we will leverage our experience to analyze and transform existing workflows to optimize both clinical and business functions. We will gauge your transition planning according to your current state in regards to staff roles and training needs.

Information Technology Systems

As with any milestone project such as a transition to an Electronic Medical Record/Practice Management system implementation or upgrade, it is an excellent time to consider your technology infrastructure as part of your planning. Of particular importance is the impending retirement of Windows XP (currently scheduled for April 8, 2014) and the impact it will have regarding your new operating system environment and the security ramifications that will need to be considered.

Business unit impact analysis

Part of a good implementation strategy is the evaluation across every facet of your organization revenue cycle. We will meet with each staff member to determine their roles and the implications upon their own workflow. During the course of our work within your practice we make every effort to identify areas of improvement in regards to efficiency and maximum revenue capture.

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Billing and Clearinghouse Functions

We will examine your current revenue cycle functions in regards to the above to determine where your revenue cycle partners are in their own preparations. Even if your practice outsources your billing there are still many considerations that must be made in regards to in-house workflow. Your implementation must be a coordinated effort between all parties involved in your revenue cycle management to minimize financial disruptions.

Financial Impact

What will the true financial implications be and how will the transition to ICD-10 impact your reimbursements? During the course of examining other business and clinical functions we will utilize the results and correlate them with your payer mix to determine any areas of concern. It is recommended that regardless of the amount of planning involved in your transition it is advisable to make provisions for an emergency contingency fund to address any financial shortcomings.

Chart and Encounter Form Audits

During the course of our engagement we will also perform chart reviews to audit for specificity and coding deficiencies. One of the reasons cited for the transition to ICD-10 is the capability for increased coding specificity. Because of the expansion of codes, conditions are ripe for claims denials due to lack of specificity and proper documentation (see clinical documentation improvement below).

Clinical Documentation Improvement

ICD-10 is populated with codes for certain diseases and conditions which rely heavily on proper documentation. Details such as site, size, specificity, and laterality are just a few details which cannot be omitted from the clinical record. This results in insufficient information for your coders and ultimately slow reimbursements and even claims denials. As part of our chart audit process we can assist you in identifying areas for improvement.

ICD-9 to ICD-10 Conversion by Specialty (Cross-walking)

The purpose of cross-walking between current ICD-9 codes and ICD-10 is to assist in the transformation process and to determine where deficiencies lie in your current environment, particularly in the areas of diagnosis codes and clinical documentation. There are instances where there is a direct correlation between the two code sets. However, there are also circumstances where a cross-walk between the two sets yields one-to-many codes as opposed to one-to-one. Additionally, you will find some instances where there are no matches between the codes.

If your practice develops your own encounter forms, or "superbills" this process will aid in the creation of new ones. We will analyze your most frequently used current codes and assist in developing the new ones which will be implemented throughout your organization. This analysis will identify the codes which must be utilized to garner the most revenue for your practice.

Dual-coding Requirements

Part of your revenue cycle involves provisioning for a dual-code environment. Your management cycle unfortunately includes claims denials and resubmissions. There will be instances during the transition period where you and your staff must operate using both ICD-9 and ICD-10 codes.

Also, some non-covered entities are not required to transition to ICD-10 though it would be in their best interests to do so. Entities that you may be affected by are automobile insurance companies and Workman's Compensation.

Another example where dual-coding might be a consideration would be for claims-based PQRS Reporting. From January 1, 2014 to October 1, 2104 (The ICD-10 transition date) ICD-9 codes are used on claims by certain specialties for reporting purposes. Obviously, registry submissions would not be affected but there are some measures that cannot be reported via registry and must be submitted via claims.

As with the above considerations Oncore will assess your current payer mix and billing practices to determine the needs of your organization regarding your dual-coding functions.

While we have listed several services and considerations that each practice must undertake in order to plan for a successful transition with minimal disruption to your practice we realize that each provider and specialty is faced with their own unique circumstances. Based upon the results of your gap analysis and needs assessment we will provide you with a customized transition plan including training plan recommendations for each staff member based upon their roles.
Oncore Associates