As the Oct. 1 compliance date looms, the American Hospital Association has published a new ICD-10 checklist, laying out key steps to keep hospitals on track for a successful transition to the new code set. See this slideshow for its suggestions. For more resources, visit the AHA website.
Internal Systems
AHA groups its suggestions under three categories – related to internal systems, partner readiness and financial protections. The chief concern under the first, it says, should be to verify whether hospitals' in-house systems and applications, including vendor software updates, are ready to work – and work together – once the switchover comes.
Internal Systems
Hospitals should take another look at their staff training processes these next few weeks, to make sure that all coders, clinicians and other employees who need to be trained are ready for the big day, according to AHA's checklist.
Internal Systems
AHA suggests an evaluation of documentation improvement efforts, including a close look at the tools to help physicians and others in preparing supportive documentation. It points out that coding teams can access ICD-10 guidelines and AHA Central Office advice here.
Internal Systems
Hospitals should also evaluate staffing levels for the ICD-10 transition, and assess whether coding productivity could drop, and by how much. It may become apparent that additional staff are needed, at least in the short term.
External Partner Readiness
AHA emphasizes the importance of making sure "trading partners" – namely, health plans – are ready for ICD-10, and establishing communication plans and policies between those organizations. It also suggests collecting emergency contact information for Medicare contractors and commercial insurers in case claims are delayed.
External Partner Readiness
Hospitals should be aware of their major trading partners' rules and process for submitting replacement claims if there are coding problems that require correcting.
External Partner Readiness
Organizations should also check with their trading partners for workers compensation, automobile insurance or other liability carriers that are not covered by HIPAA, according to AHA, to ensure they'll be transitioning to ICD-10; it's important to understand the steps needed to limit delays in payment from these payers.
Financial Protections
AHA suggests establishing metrics that track current claims volume along with associated monetary amounts, thereby creating a baseline for tracking future claims volume submitted and processed.
Financial Protections
Once the compliance date has arrived, hospitals should closely monitor the status of submitted claims to learn whether problems are occurring so they do not turn into financial hardships, according to AHA. It points out that claim status inquiries are available from health plans either through their Web portals or through health plan utilization of the HIPAA transaction standard for claim status.
Financial Protections
Hospitals should be sure to learn the policies and processes of their trading partners with regard to advance payments if they experience any payment delays. AHA points of that the Centers for Medicare & Medicaid Services has procedures providers can follow for payment advances from Medicare in the event of a lag in Medicare billing and/or payments. Access them at the CMS website.
Financial Protections
AHA suggests hospitals consider establishing credit lines that can be used, in case processing delays adversely affect their normal revenue cycle.
