Preparing for ICD-10, CMS goals for Small and Medium Sized Practices

This is a pretty good time to check and see if you’re on track for ICD-10 implementation. According to the Centers for Medicare and Medicaid Services (CMS), that means small- and medium-sized medical practices should have completed some goals.

Planning

These steps should be completed:

• Identify resources
• Create project team
• Assess effects
• Create project plan
• Secure budget

Communications

Practices also should have:

• Informed staff
• Contacted vendors
• Contacted payers

Medical practices need to stay in contact with their vendors and payers to track and monitor their ICD-10 progress. Hopefully contingency plans won't be needed.

Testing

Key personnel involved in ICD-10 testing should be trained. And CMS recommends testing the following elements for internal testing:

• Database architecture
• User interfaces
• Algorithms based on diagnosis or institutional procedure codes
• Code aggregation (grouping) models
• Key metrics related to diagnosis or institutional procedure codes
• All reporting logic based on diagnosis or institutional procedure codes

That should be completed so medical practices can begin external testing with healthcare payers, which should include:

• Determine if the payer has educational programs and collaboration efforts to support providers through the transition
• Use the high-dollar, high-volume, high-risk scenarios that your practice has created to produce test claims
• Work with payers to develop test scenarios to conduct end-to-end testing, specifically identifying payment results
• Communicate coding practices and scenarios to payers to build better relationships throughout the testing and transition process
• Identify communication processes to identify and correct issues early with payers
• Test information exchanges with hospitals to ensure appropriate handling.
• Test healthcare information exchanges for critical operations to meet interoperability standards.
• Test outsourced coding and billing operations with defined clinical scenarios to make sure these business operations continue as expected.

Local and national government entities may require reporting for a variety of purposes including:

• Public health reporting
• Quality and other metric reporting related to meaningful use
• Medicare and Medicaid reporting and data exchange
• Other mandated or contractually required exchange of information around services and patient conditions

The external testing should be going on through Oct. 1. Mostly because not all trading partners will be at the same level of preparedness.