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December 28, 2010

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ICD-10 : A Practical Guide to Conversion: Part I: Taking a closer look

A s with any complex undertaking, it’s best to begin by gathering your resources, so we begin with a resource guide to ICD-10 information. ICD-10 has fallen under the purview of the healthcare reform movement and so is not a static requirement—in fact as recently as last week, CMS published significant changes to the ICD-10 for 2011 that added 124 new codes to the 72,081 total new codes in the conversion tables.

ICD-10 is actually one of the principal opportunities for healthcare savings and is continuing to evolve even as implementation dates get nearer. The most recent changes are in response to a requirement in the Affordable Care Act to review and update ICD-10 requirements to optimize savings. So for any organization preparing for the conversion, an important first step is to arm yourself with information and signup to receive the latest updates from the source.

Where can I go to get accurate information about ICD-10 and related requirements?

CMS is responsible for implementing the conversion from ICD-9 to Version 5010 (due January 1, 2012) and ICD-10 (due October, 2013).

The CMS website at www.cms.gov offers a wealth of clear, accurate, and official information about the whens, whats, whys, and wherefores of the conversions. The only drawback is that this information is included within the context of a lot of other CMS-related information—the website is the epitome of information overload, so to help you find your way, here’s a quick guide in FAQ format to the most relevant pages covering ICD-10.

1. What’s the best place to start? The CMS Home Page for ICD-10 at www.cms.gov/ICD10/ is the gateway for most official information related to ICD-10 conversion. There is also a brief ICD-10 introduction available on the site.
2. Who is required to do what, when? CMS publishes and updates an ICD-10 conversion timeline (which includes dates for Version 5010 conversion as well). The first deadline is December 31, 2010.
3. Do I need to do anything about the 5010 (or DO) conversion in 2011? Pharmacies and certain health care providers (as well as coverage plans) are subject to this regulation. Check the CMS 5010 home page to see if you’re included.
4. Where can I find more resources to help with the transition? PBN intends for this Four Part Guide to be a primary resource to help you implement the required conversion. If you’d like a very short introduction, CMS has published a related ICD-10 Conversion Fact Sheet that provides a kind of executive overview. Otherwise, look forward to the other installments in this series and check out these resource sections of the CMS website:
   
   

   Healthcare Provider Resources

   Medicare Fee-for-Service Provider Resources

   Medicaid Resources

   Payer Resources

   Vendor Resources

   
   
   
5. Where can I find the actual regulations requiring these changes? You can go directly to the CFR online or access the specific regulations from the related ICD-10 Statutes and Regulations page on the CMS website.
6. How can I get the latest news about this? You can sign up to receive ICD-10 and other CMS-related updates by email here: subscriptions.cms.hhs.gov/service/subscribe.html?code=USCMS_608

Finally, some key points to remember as you get started

While the provision that requires ICD-10 implementation by the published due dates is driven by Medicare and Medicaid billing and payment restrictions, the regulation is broader than that.

ICD-10 is not just about qualifying for Medicare/Medicaid claims. The regulations requiring ICD-10 (and 5010) code sets were passed under the HIPAA regulations and will apply to all transactions that fall under HIPAA not just Medicare and Medicaid claims. That means the requirements apply to just about anything that a doctor or pharmacist bills to any patient, to Medicare or Medicaid, or to any other entity—so yes, it applies to you.

ICD-10 applies to more than just billings. “Transactions” covered under the requirements include, “claims and encounter information, payment and remittance advice, claims status, eligibility, enrollment and disenrollment, referrals and authorizations, and premium payments.” Many of these transactions also are also required under the overlapping EHR requirements (which are separately required for Medicare and Medicaid reimbursements before 2015).

You don’t have to do it all on your own. Third party vendors (including billing and practice management companies like PBN) must also comply with the new regulations and can help you get up to speed quickly. Even if you don’t plan to use the services of a third party vendor to help you comply, you need to coordinate with your vendors to ensure that they are up to date and compliant with the requirements.

To find out how PBN can help your practice move forward with ICD-10, contact . . .

PBN Business Development, 800.288.4901,

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Overland Park, KS 66210 | 800.288.4901 | pbnmed.com

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