Academy provides checklist for conquering the switch to new U.S. medical billing system
SAN FRANCISCO — As the first trial of the new ICD-10 medical billing system approaches in March, the American Academy of Ophthalmology, the world's largest association of eye physicians and surgeons, is urging ophthalmologists to initiate their preparation and training for the switch to the new coding system well ahead of the October mandate.
ICD-10 stands for the International Classification of Disease, 10th revision code set, which replaces the ICD-9 codes created by the World Health Organization in 1979. In addition to the Affordable Care Act, the switch this year to ICD-10 represents one of the most significant changes to affect the American health care system in decades. In October, all U.S. health care providers will need to use ICD-10 codes to report medical diagnoses. The new codes will be longer, and the number will jump from roughly 14,000 ICD-9 codes to nearly 70,000 ICD-10 codes, requiring health care providers to rapidly learn thousands of new codes. ICD-10 Testing Week, from March 3-7, will serve as one of the first technical tests of the new codes by registered providers and claims processing vendors.
Without proper training and preparation, physicians – as well as hospitals and other healthcare providers – face loss of reimbursement due to denied claims. This motivation has resulted in record attendance at the Academy-developed four-hour state- and ophthalmology-specific ICD-10 CODEquest training courses, and rapid sales of its coding guides.
The American Academy of Ophthalmology Executives, the practice management division of the Academy, runs the CODEquest program and provides the following "Conquering ICD-10 Checklist" to help practices prepare for implementation:
- Identify an ICD-10 coordinator or coordinators.
- Identify all vendors, systems and staff affected by the change.
- Identify all forms and practice templates that need to be updated.
- Estimate a budget, including costs associated with software and education.
Get Your Systems Ready – Vendor/Partner Readiness
- Communicate with your vendors and upgrade to the version that supports ICD-10.
- Confirm vendors have uploaded ICD-10-CM codes.
- Confirm that system vendors, clearinghouses and/or billing services will support changes to new code system.
- Query your most frequent commercial insurance payers regarding their timing or testing.
Paper Charts or EHR Readiness
- Work with vendor to upgrade your claims submission system to support new CMS 1500 form and electronic data interchange EDI format.
- Participate in ICD-10 test week, March 3-7.
- Strikethrough or delete unspecified codes which are not payable codes from system.
- Identify opportunities for improved documentation in chart templates and EHR electronic health records to support ICD-10.
- Run diagnosis-productivity report by physician.
- Convert most frequently reported codes to ICD-10.
Process and Document Readiness
- Order CMS 1500 forms, mandated for April 1 implementation.
- Request and review insurance policies and prior-authorization requirements with new ICD-10 codes.
- Create electronic libraries of diagnosis code options.
- Update all templates and other forms that previously used/followed ICD-9 codes.
- Develop superbills or charge sheets.
"Many ophthalmic practices are proactively training and preparing for ICD-10 well in advance of the October deadline as it is time-consuming and for some, an overwhelming process," said Sue Vicchrilli, coding executive for the American Academy of Ophthalmology. "The Academy is uniquely positioned to provide them with the most comprehensive coding education and resources available for the profession of ophthalmology. Our goal is to ensure that practices can appropriately maximize reimbursement by submitting claims correctly – the first time – and audit-proofing their documentation."
For more ICD-10 training and resources available through the Academy, visit www.aao.org/icd10.
About the American Academy of Ophthalmology
The American Academy of Ophthalmology, headquartered in San Francisco, is the world's largest association of eye physicians and surgeons — Eye M.D.s — with more than 32,000 members worldwide. Eye health care is provided by the three "O's" – ophthalmologists, optometrists, and opticians. It is the ophthalmologist, or Eye M.D., who has the education and training to treat it all: eye diseases, infections and injuries, and perform eye surgery. For more information, visit www.aao.org.
<class=subheading>About the American Academy of Ophthalmic Executives
The American Academy of Ophthalmic Executives AAOE, the practice management division of the American Academy of Ophthalmology, offers practice management information, programs, products and services designed to address the roles of ophthalmic administrators, office managers, managing physicians and billers/coders. For more information, visit www.aao.org/aaoe.