ICD-10 Postponement May Cause More Problems than it Solves

ICD-10 Postponement May Cause More Problems than it Solves

With ICD-10 changes postponed until 2015, many providers started to relax. But a recent article in Healthcare Finance warns that this might actually place a greater burden on mental and behavioral health organizations. Cited in the article, Nina Marshall, Director of Public Policy at the National Council for Behavioral Health, highlighted that these organizations are already working on the changeover to the newest version of the Diagnostic and Statistical Manual of Mental Disorders. “A lot of providers are asking questions about whether they need to continue to focus on it now (ICD-10) and asking what it does for DSM-5 implementation,” she stated.

Marshall believes that while it was recommended that groups change to DSM 5 in January 2014, many are waiting to tie implementation to the ICD-10 changes. The result is that providers and insurers are working simultaneously on a mix of DSM-4, DSM-5, ICD-9 and ICD-10[1].

Don’t take your foot off the gas

Unlike previous seismic healthcare changes, where mental and behavioral health organizations were relatively immune, ICD-10 can have a significant impact on your practice’s financial health. And when combined with the clinical standards of DSM 5, it exponentially increases the complexity that you may now face.

Now is not the time to slow down on preparing for ICD-10. The following tips are recommended by the Centers for Medicare and Medicaid Services for small-to-medium organizations to prepare for the ICD-10 transition.

-Review available ICD-10 resources from CMS, trade associations, payers, and vendors

-Inform your staff/colleagues of upcoming changes

-Create an ICD-10 project team

-Identify how ICD-10 will affect your practice

  • How will ICD-10 affect your people and processes? To find out, ask all staff members how/where they use/see ICD-9

-Develop and complete an ICD-10 project plan for your practice

  • Identify each task, including deadline and who is responsible
  • Develop plan for communicating with staff and business partners about ICD-10

-Estimate and secure budget (potential costs include updates to practice management systems, new coding guides and superbills, staff trainings

-Ask your payers and vendors — software/systems, clearinghouses, billing services—about ICD-10 readiness

  • Review trading partner agreements
  • Ask about systems changes, a timeline, costs, and testing plans
  • Ask when they will start testing, how long they will need and how you and other clients will be involves
  • Select/retain vendors

-Review changes in documentation requirements and educate staff by looking at frequently used ICD-9 codes and new ICD-10 codes (ongoing)[2]

CMS also advises that practices confirm with their vendor that their PM system has been upgraded to Version 5010 standards, which have been required since January 1, 2012. Unlike the older Version 4010/4010A standards, Version 5010 accommodates ICD-10 codes[3].

Dealing with ICD-10 within the community

When planning your transition, you must consider how and when your partners and payers will be making the jump to ICD-10. What they are doing will affect your revenue stream, so you need to know what their timeline is for the changeover. In the case of payers, both public and private, do you know what combination of DSM-5 and ICD-10 codes they will require? How will you handle these both clinically and administratively? You will also need to consider how payers are mapping reimbursement schedules. How will their changes impact your revenue and contracts?

ICD-10 is coming. By having the right preparation, you can mitigate the pain of the transition. And by understanding how your community is handling reimbursements, you can mitigate the impact on your own organization’s critical revenue.


[1]Tammy Worth, “Behavioral Health Providers Unprepared for ICD-10 Transition,” Healthcare Finance News, (April 28, 2014), http://www.healthcarefinancenews.com/news/behavioral-health-providers-unprepared-icd-10-transition

[2] “Small and Medium Practices ICD-10 Transition Checklist,” The Centers for Medicare and Medicaid Services, (January, 2013), http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10SmallMediumChecklistTimeline.pdf

[3] “ICD-10 Basics for Medical Practices,” The Centers for Medicare and Medicaid Services, (June, 2013), http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10_Basics_for_Medical_Practices_060413%5b1%5d.pdf


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