Providers Must Prepare as ICD-10 Deadline Approaches

After several delays in the deadline for transitioning to the ICD-10 medical coding system, industry observers seem confident that the current October 1, 2014, deadline will stand. That means all health care providers have less than a year to be in compliance with the new system.

What if you are not ready? Although the government has not announced specific sanctions for non-compliance by health care providers, some have estimated that penalties for non-compliance could be anywhere from $25,000 to more than $1 million per violation. And of course, once Medicare and Medicaid make the switch, along with most private insurers, billings submitted using the old coding system will likely be rejected.

Even if you are on time for making the transition, experts warn that providers should be prepared for serious slowdowns in reimbursements, along with disruptions in operations and losses in productivity until both systems and humans get up to speed. Nervous references to the rocky rollout of healthcare.gov abound.

In the meantime, the Centers for Medicare & Medicaid Services recommends formulating a clear ICD-10 Project Plan and offers guidelines for a smooth transition:

  • Identify specific tasks to be completed, by whom and by when, and monitor your progress against the plan.
    • Devise a comprehensive, realistic budget.
  • Allow time for software and hardware testing.
  • Schedule training of clinicians, office managers, billers, coders and other staff members.
  • Examine whether any internal policies, business practices or documentation procedures must be adapted to support the transition.
  • Identify your most commonly used ICD-9 codes and their related ICD-10 codes.
  • Verify that your vendors and clearinghouses or billing services are ICD-10-ready, and consider whether you may need to change any vendors.

Do not be caught out of compliance with ICD-10 or any other regulatory requirements. If you have questions, contact a reputable health care attorney for compliance counseling.

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Posted in: Compliance