Keeping you on course... 

On October 1, 2015, the ICD-9 code sets used to report diagnoses will be replaced with ICD-10 code sets.

Payors anticipate the conversion to ICD-10 will create significant delays in the processing of health care claims, which can result in a significant reduction in your revenue stream.

HNS has created the following ICD-10 Action Plan to ensure your practice is ready for ICD-10 and to help ensure your revenue stream remains steady throughout the ICD-10 transition process.

ICD-10 Readiness Action Plan

Six hour ICD-10 Seminar (approved by the NC and SC Board of Examiners is now available on the secure section of this website!)

Important Note about PI and Worker's Comp
Auto, personal injury and Worker's Comp are exempt from HIPAA regulations. As such, entities processing claims associated with PI and Worker's Comp are not required to use ICD-10 Codes, so those entities may continue to use ICD-9 codes. If you treat PI and Worker's Comp cases, your software will need to be able to handle both the ICD-9 and ICD-10 code sets simultaneously.

1.  Review the ICD-10 section of the HNS website

To get started, carefully review all of the important information and ICD-10 deadlines in this section of the website.

2.  ICD-10 Readiness Staff Meetings

Hold ICD-10 readiness staff meetings.  Begin with a review of all operational systems and processes in your practice that may be impacted by ICD-10.

Create an inventory of everywhere your ICD-9 codes are currently used (such as paper and electronic health records, software, superbills, clinical documentation, quality reporting (PQRS), and internal and external forms), and identify changes needed.

Review each of the important ICD-10 deadlines, including those established by key stakeholders, such as your billing company and/or clearinghouse.

Develop a list of actions that must be taken and changes that must be made and prioritize based on above timelines.

Establish the person or party responsible for making the change(s) and create internal timelines for completion in advance of the actual deadline.

Continue to hold weekly or bi-weekly meetings to monitor your progress and adjust action steps as needed to ensure your practice's readiness.

3.  Communicate with your Practice Management Software System Vendor

Make sure your practice management software can accommodate all the changes associated with ICD-10.  Here are some questions to ask your software vendor.

1. 1. Can my current version handle ICD-10, including the longer code lengths?  If not, will a new version be available well in advance of the October 1, 2015 deadline?
   2. If an upgrade to my software is required, will there be a cost to me for the upgrade?
   3. Can my current software produce an 837p 5010 electronic claim file, and if not, will the new version be able to generate the claim file in the required 5010 format by the April 1, 2015 deadline?
   4. Can my current version accommodate the changes to the revised CMS 1500 claim form (02/12)?
   5. Dual use. Because ICD-10 is date driven, services provided prior to October 1, 2015 must be billed with ICD-9 codes while services on or after October 1, 2015 must be billed with ICD-10 codes.  Verify with your vendor that your system can accommodate this requirement. Additionally, it is important to note that worker's compensation, auto and personal injury insurance are exempt from HIPAA, therefore they may not be using ICD-10, so your office may have to utilize both ICD-9 and ICD-10 codes.
   6. Since ICD-10 is only being used for dates of service on or after October 1, 2015, will the patient accounts hold both ICD-9 and ICD-10 codes and choose the right ones based on the date of service?  Or will we have to set up new patient accounts that use only ICD-10?
   7. How will my software handle the "X" placeholder and the 7th character requirement?

 4.  Communicate with your billing service and/or clearinghouse

Communicate with your billing service and/or clearinghouse to determine whether they are prepared for ICD-10.  Obtain a timeline from these vendors to ensure that any updates will be made well in advance of the ICD-10 October 1, 2015 effective date.

5.  Learn the new ICD-10 codes (Watch the ICD-10 Online Webinar)

It is imperative that you understand the basics of the ICD-10 code structure and the fundamentals of ICD-10.

First, review the information on the anatomy and structure of the ICD-10 code sets included in this section of the website.

Next, determine the most frequently reported diagnosis codes in your practice by running a diagnosis report from your billing software.Compare this report to the codes on the HNS Code Translator. The HNS Code Translator was prepared for HNS by Dr. Mario Fucinari, an expert in ICD-10 for chiropractic, to help you select the most appropriate ICD-10 codes. The Code Translator includes a list of the top 100 ICD-9 codes most frequently reported by HNS providers, and the possible corresponding ICD-10 codes. This tool is available on this website.

While the Code Translator will be very helpful, there are many codes for which there is no direct crosswalk from ICD-9 to ICD-10. 

An additional resource for your practice is Dr. Mario Fucinari's ICD-10 Coding of the Top 100 Conditions for the Chiropractic Office. This book is an excellent resource for your practice, is only $65.00, and is available on Dr. Fucinari's website, www.askMario.com (click on 'Store").

An alternative resource for your practice is ChiroCode's ICD-10 Coding for Chiropractic (Second Edition). HNS has negotiated a 10% discount (plus free shipping and handling) for HNS providers. Information on how to order and receive the discount is included on this website.

6.  Educate your staff

While your coders will need the most training, most of your office personnel will need some degree of ICD-10 training, including training on workflow changes.

7.  Assess your documentation

ICD-10 requires a greater degree of specificity and clinical detail.  Review the revised HNS Documentation Policies and utilize the HNS Self-Assessment Documentation Form to assess your current documentation practices to ensure they will support the ICD-10 codes you will be reporting.

8.  Test

If you are submitting claim files electronically to a clearinghouse, or directly to a payor, contact them to schedule ICD-10 testing of your claim files.  If you are using a billing service, make sure they have completed their testing.

9.  Arrange for a line of credit with your bank

Payors, both government and commercial, anticipate significant delays in the processing and payment of claims during the transition process.  While we hope you won't need it, play it safe and arrange for a line of credit with your bank in the event you experience cash flow problems during the transition period.

10.  Keep your billings current

Between now and October 1, 2015, keep your billings up-to-date and stay on top of your accounts receivable.  Toward the end, HNS strongly recommends you do the following:

1. 1. Submit ALL electronic claim files and ALL paper claims (secondary, corrected, etc.) at least weekly between now and the end of July 2015.
   2. During the months of August and September, the final two months prior to the 10/01/15 effective date, submit ALL electronic claims files and ALL paper claims (secondary, corrected, etc.) on a daily basis.
   3. Between now and the end of September, carefully check your HNSConnect® account for claims with errors each day and promptly correct and file any claims that could not be forwarded to the payor.
   4. Review your aging reports each week between now and the end of September and promptly research/trace all claims over 30 days old.

Remember These Important Deadlines:

Other ICD-10 Deadlines:

• • Effective October 1, 2015, payors will only accept electronic claim files submitted in the required 837p 5010 file format.
  • Effective October 1, 2015, diagnoses reported on health care claims for dates of service on or after 10/01/15 must be represented by ICD-10 codes.