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Home Health Care: Preparing for ICD-10

Changes Ahead

Effective October 31st 2014 (Update: Effective date moved to October 1, 2015), all Home Health agencies will be required to convert to ICD-10 coding for their OASIS and 485s. All health care entities, including hospitals, nursing homes, physicians, and home health are converting.  With major changes of this type, the conversion from ICD-9 to ICD-10 will create challenges for all concerned, especially for those not adequately prepared.

The changes bring mixed reactions. The big question is to why this change to ICD-10 is needed. According to the Center for Medicare and Medicaid Services (CMS), the primary reasons for the conversion are:

ICD-9 codes provide limited data about patients’ medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, it has outdated and obsolete terms, and is inconsistent with current medical practices. Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full.

ICD-10 codes allow for greater specificity and exactness in describing a patient’s diagnosis and in classifying inpatient procedures. ICD-10 will also accommodate newly developed diagnoses and procedures, innovations in technology and treatment, performance-based payment systems, and more accurate billing. ICD-10 coding will make the billing process more streamlined and efficient, and this will also allow for more precise methods of detecting fraud.

CMS recommends the following steps, for your home care agency to make the successful conversion from ICD-9 to ICD-10 coding.

  1. Establish a transition team or ICD-10 project coordinator, depending on the size of your organization, to lead the transition to ICD-10 for your organization.
  2. Develop a plan for making the transition to ICD-10. Include a timeline that identifies tasks to be completed and crucial milestones/relationships, task owners, resources needed, and estimated start and end dates.
  3. Determine how ICD-10 will affect your organization. Start by reviewing how and where you currently use ICD-9 codes. Make sure you have accounted for the use of ICD-9 in authorizations/pre-certifications, physician orders, medical records, super bills/encounter forms, practice management and billing systems, and coding manuals.
  4. Review how ICD-10 will affect clinical documentation requirements and electronic health record (EHR) templates.
  5. Communicate the plan, timeline, and new system changes and processes to your organization. Ensure your leadership and staff understand the extent of the effort the ICD-10 transition requires.
  6. Secure a budget that accounts for software upgrades/software license costs, hardware procurement, staff training costs, revision of forms, work flow changes during and after implementation, and risk mitigation.
  7. Talk with your payers, billing and IT staff, and practice management system and/or EHR vendors about their preparations and readiness.
  8. Coordinate your ICD-10 transition plans among your trading partners and evaluate contracts with payers and vendors for policy revisions, testing timelines, and costs related to the ICD-10 transition.
  9. Talk to your trading partners about testing. Create a testing plan.
  10. Coordinate your ICD-10 transition plans among your trading partners and evaluate contracts with payers and vendors for policy revisions, testing timelines, and costs related to the ICD-10 transition.

The transition to ICD-10 involves new coding rules, so it will be important for payers to review payment and benefit policies. Payers should ask software vendors about their readiness plans and timelines for product development, testing, availability, and training. Also ask billing services and clearinghouses, as well as the providers you work with, what they are doing to prepare and what their timelines are for testing and implementation. In order to upgrade to ICD-10 successfully, it is important to coordinate with business trading partners and test processes and transactions that use ICD-10 codes from beginning to end. It also is important to review and evaluate trading partner agreements and contracts.

The ICD-10 Implementation Guide for Payers and the payer implementation timeline and checklist on the “Payer Resources” section of the CMS ICD-10 website provide detailed information for planning and executing the transition.

You have one year left to prepare and train your staff for this transition. As you can see in the steps outlined by CMS, it is a full industry readiness that needs to be in place. The conversion from ICD-9 to ICD-10 will not just affect your agency but all the vendors and other providers with whom you work.

Although Kenyon HomeCare Consulting has an established OASIS review and ICD-9 (soon to be ICD-10) coding division to whom your OASIS coding can be outsourced, it will not prepare the internal and operational changes that are needed for your home health agency to succeed in this transition.

If you find you are having difficulty with preparations for the transition and/or currently need assistance with your OASIS/ICD-9 coding, please contact Ginny Kenyon at and schedule a time and day that works for you to talk. We are here to help.

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Category: ICD Coding, Legislation/Reform, Specialized Support

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