Check Your Contracts … NOW

By Rhonda Buckholtz, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC

Have you begun your planning for ICD-10 implementation? By now all organizations should be in the planning stages and doing an impact analysis to ensure implementation success.

One hidden danger zone that could derail your best laid plans and your budget are contracts. Take a good hard look at both the vendor contracts that you have and any health plans you are contracted with.

One key area in vendor contracts to zone in on is how you are charged for upgrades. There is no doubt major upgrades will be necessary behind the scenes in order to even be able to submit the new codes. How will you be charged for these updates? Do you have a clause worked into your contract that addresses governmental changes or will you need to work with your vendors on the cost of upgrades?

For every health plan you are contracted with, you need to check on how transactions might be made in the future. Have you been successful in negotiating carve outs or payments for devices or other services? If so you will need to work to make sure that you continue getting paid. Consider all of those health plans you are contracted with and how many of their policies are now currently tied to ICD-9 codes. Careful planning is needed to work with these plans to make sure you continue to get paid after October 1, 2013.

Successful implementation of ICD-10 goes far beyond the code sets, and careful planning needs to occur now. Any delays on your part now in working with vendors and health plans could be detrimental to your success and your financial bottom line.

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