ICD-10: Tips from TIMS

Carolyn Smaka: Thanks for your time, Jerod.  My first question is, what should audiology practices know about ICD-10 – what kind of changes can they expect?

Jerod Schaefer: There are a couple of important things to note about ICD-10.  ICD‑10 does not replace CPT codes. They are only replacing diagnostic codes. 

One of the biggest changes that audiology practices, especially those that also provide speech therapy services, will see is that there are many more diagnostic codes in ICD-10. Overall, there are about four times as many codes in ICD-10 as compared to ICD-9.  In some cases, there are six new ICD-10 codes that correspond to one ICD-9 code.  Practices will need to be become familiar with all the new codes and understand which ones to use in which cases. As you know, the selection of the proper ICD‑10 code is critical for getting paid in a timely manner.

Carolyn: Who exactly needs to use ICD-10 codes?  Does this affect all hearing care practices?

Jerod:  If you’re covered by HIPAA, you need to convert to ICD‑10. There's no way to get around that. 

Carolyn: When is the implementation date or deadline for transition to ICD-10?

Jerod: The date for transition to ICD‑10 is October 1st, 2015. Whether you use ICD-9 or ICD-10 depends on the date of service.  Claims for services rendered on September 30 or before should use ICD-9 codes.  For patients seen and services provided on or after October 1, ICD-10 must be used, regardless of the date you actually file the claim.

One of the challenges that presents, is that you will have a time where you need to have both ICD‑9 codes and ICD‑10 codes ready in your database to be able to submit claims. 

Carolyn:  What are the advantages of using TIMS in regard to this issue? 

Jerod:  One of the things that we've created within TIMS to help manage the transition from ICD‑9 to ICD‑10 is a Conversion Tool.  Anyone using TIMS can access it, and there is no charge to use it.  Using the Conversion Tool, you enter an ICD-9 code and the software locates all the corresponding ICD-10 codes.  Then, it's easy to select the ones you want to add.  You can change any description information and then automatically import those ICD‑10 codes into the database.  This document guides you through converting your existing ICD-9 codes to ICD-10 in TIMS.

One of the convenient things about that is that you can load both ICD‑9 and ICD‑10 codes in your system.  We recommend you start loading the ICD-10 codes now and get well ahead of the deadline because by mid-September it will be crunch time.  The Conversion Tool is a big timesaver and helps, but it still does take a considerable amount of time to work through all the codes and understand which codes to use in which situations.

Our claims clearinghouse has been ready for the switch for about a year. They've done all the necessary testing and we’re ready to go.

We’ve also done some work to help with the selection of diagnostic codes during the treatment process. We’ve created an auto complete in our electronic super bill that works much like Google’s auto complete does. When you start typing any part of the diagnostic code, whether it's the numeric indicator or part of the description, it will give you a list of items that match those characters, and you can select from that list.

For example, if you type begin typing the word “conductive,” TIMS will display only those codes containing that word.  This reduces the list of possible codes from hundreds to a very short list from which you can easily select the correct code.

Carolyn:  Auto complete is definitely a huge timesaver.  What other tips do you have for professionals for the ICD-10 transition? 

Jerod:  Once ICD‑10 implementation begins, it will be extremely important to monitor and verify how quickly your claims are being processed by the clearinghouse and by the payers or you run the risk of missing out on potential revenue.  These new codes may be a reason for insurance companies to delay and possibly lose more of your insurance claims.  It’s more important than ever to be on top of your game when it comes to billing and follow up.

To manage this, make sure that you have work flows in place that give you the opportunity to ensure that your claims are being processed. Check on the status from the clearinghouse. Check on the status from the payers and stay on top of your claims.

For the first several months after ICD‑10 implementation begins, it is recommended that offices randomly pick ten to twenty claims and carefully examine them. Look at all the payer notes, the clearinghouse notes and the claims status.  This type of check will give you a pretty good idea of the insurance companies that are processing claims effectively and those that aren't. 

Carolyn:  Sounds like you are recommending a self-audit. 

Jerod:  Yes.  With TIMS, you have all the patient information, the insurance information, the clearinghouse information, and the claim information all in one location in the software immediately available and accessible whenever you need it.   You do not need to jump around between websites, paper files, or other software applications to find all this important information. With TIMS, all of the information vital to successful claims management is at your fingertips. If you're using the ERN service, not only will you get paid faster and save time in adjudication, but you'll be able to get those results faster and get the claims that have been processed through the system and completed. That way, you can focus your time on the ones that might be stuck at the clearinghouse or stuck at the payer. 

With TIMS, you have plenty of reporting to tell you where your claims are in the process. Assign a dedicated person or team to follow up on outstanding claims on a regular basis, anywhere between every four to six weeks.  Ensure the claims are being followed up on.   Have consistent accounts receivable follow up. TIMS provides an easy way for your team to manage this entire process. 

Another suggestion is to establish a follow up person or team to go after money that's been lost for one reason or another. For example, if something gets rejected, make sure that you check those payer notes and follow up on them.  Determine if there is something in the work flows that you can change to make sure that the claims are being submitted correctly.  Again, with the increased number of codes in ICD-10, it is more critical than ever to select the correct code.  Since ICD-10 brings new codes and more codes, there is more room for error on both the provider side and the payer sides of the equation.

If you do get a rejection, don't just take the first rejection as gospel. Make sure that you check up on it. Follow up and see what else you can do.  Make sure you get some training on ICD-10 and on billing that can provide you with guidance and skills.  AudiologyOnline’s Billing and Coding Bootcamp is one great resource out there, and there are others as well.

Lastly, I want to stress that this transition is a great time to move to an electronic superbill for those offices that have not already done so.  A paper super bill will become unmanageable with hundreds of ICD‑10 codes. An electronic super bill system is the only way that you're going to manage this work flow process effectively, without having a negative impact on your patient care. 

Carolyn:  You make a great point that I hadn't thought about, which is this is new for everyone – not just providers.   It's going to be a learning curve. 

What are the most common questions people have about ICD-10?

Jerod:  The most common question is, “Will there be a matching ICD‑10 code for every ICD‑9 code?”

The answer is, it depends. Some ICD-9 codes do have a direct correlation in ICD-10, and some do not.  With our Conversion Tool, the ICD-10 codes are fairly easy to research. 

The second question we hear is, “Will the deadline for ICD-10 be delayed again?”.

As you may know, the original implementation date for ICD-10 was October 1, 2013, but was pushed back to 2014. Then October 1, 2014 became October 1, 2015.   There is very little likelihood at this point that the deadline will be moved again. 

Another question we get is, “Is TIMS ready for ICD-10?”. The answer is yes, absolutely.  A follow up question to that is, “Is the clearinghouse ready for ICD-10?”, and that answer is also yes. 

We’re also asked, “Where do I find those ICD-10 codes?”.  The Conversion Tool helps you with that. 

Carolyn: Thanks for the information, Jerod!   For more information about TIMS and ICD-10, please visit timssoftware.com/audiology or the TIMS Audiology Software Expo Page on AudiologyOnline.