Posted in ICD-10 & Coding

The road to ICD-10 implementation is now a race

Carl Natale
by Carl Natale

We need to stop calculating the odds of another ICD-10 delay and get to work. There is less than nine months to be ready for ICD-10 implementation.

According to the Centers for Medicare and Medicaid Services (CMS) Road to 10 planning tools, medical practices should be this far in the ICD-10 transition:

Planning (Should have been finished already so get on it now)

  • Create an ICD-10 team
  • Create an internal impact assessment
    • List work processes and current electronic systems that use ICD-9 codes. The AMA suggests looking at:
      • Claims submission
      • Billing system
      • Posting payments
      • Clinical documentation, e.g., patient reports, electronic medical record
      • Patient registration system
      • Checking patient’s eligibility
      • Verifying referral/prior authorization
      • Writing referrals
      • Writing orders
      • Encounter forms
      • Coding tools, e.g., “superbills”, programs, books, resource materials
      • Quality reporting
      • Public health reporting
      • Disease registry/disease management
      • Health insurance contracting
      • Laboratory systems
      • Where else?
    • Evaluate how ICD-10 will affect your practice
      • Identify the diagnoses most frequently used.
      • Look up these diagnoses and review the potential new codes for the best match.
    • Identify staff who work with ICD-9 codes and how their job relates to those codes.
      • Understand how your clinicians and coding/billing personnel communicate.
      • What words do they use to describe their routine protocols to medical coders/billers?
    • Identify possible work flow changes needed to implement ICD-10 codes (e.g., data collection forms, encounter forms, superbills)
      • Medical coding
        • Training for medical coders
        • Increased to time to process medical claims
        • Managing the increased queries for physicians and clinicians
      • Physicians and clinicians
        • Clinical documentation
        • Quality improvement
        • Case management
      • Information technology
        • Upgrades
          • Internally (home grown) developed applications
          • External applications (Review contracts for commercial information system applications)
        • Reporting
          • Generating reports
          • File exporting
        • Data entry
          • Inputing
          • File importing
        • Data warehousing
        • Decision support
        • Research
      • Financial management and revenue cycle
        • Productivity
        • Reimbursement Structures
          • Contract negotiations
          • New reimbursement policies
        • Pre-Authorization
        • Eligibility
        • Scheduling
        • Admitting/Registration
        • Charges, Coding
        • Claims/Billing
        • Collections/Follow-up
        • Payment Posting
        • Denials Management
        • Education/Training
      • Business practices
        • Referrals
        • Authorizations/pre-certifications
        • Patient intake
        • Physician orders
        • Patient encounters
      • Clinical documentation: The increased specificity will require that patient encounters are documented with with greater detail.
        • Impacts
          • Staff training
          • Physician workflow
          • Patient volume
          • Forms, documents, and encounter forms need to be revised to reflect ICD-10 codes
          • Processes for ordering and reporting lab/diagnostic services to health plans
        • Evaluate whether clinical documentation can support ICD-10 specificity
        • Prepare clinical documentation improvement (CDI) strategies
        • Identify how staff will enter key words, medical notes and content in medical records.
    • Determine if hiring a consultant is needed as a part of your implementation process
  • Figure out how much the ICD-10 transition will cost.
    • Focus on four areas:
      • Coding
      • Revenue cycle
      • Project management
      • IT
    • Each area requires resources - time and money - to accommodate:
      • Software and hardware
        • In house and vendor modifications
        • Upgrades
        • New software, systems and equipment
      • Education
        • Coder training
        • Clinician education
        • Awareness raising
      • Testing related costs
      • Staff time needed for:
        • Implementation planning
        • Training
        • Testing
        • Vendor management
      • Temp staffing to assist with extra work resulting from:
        • Decreased coding productivity
        • Billing backlogs
        • Claims denial and rejection management
        • IT work on upgrades and systems
        • Lost time during training
      • Consulting services
      • Forms and reports
        • Redesign
        • Printing costs
      • Data conversion
      • Dual coding
        • Added time
        • Maintaining data collection
        • Analyzing data

It looks like a lot but it's doable. The goal is to understand what medical practices will need to do to be ready Oct.1.

In a nutshell, the rest of 2015 will be spent on:

  • Conduct training (Keep training until June 1 then practice)
    • Obtain Clinical Documentation Education Ongoing Practice and Validation
    • Obtain Coding Education
    • Obtain ICD-10 Overview Education
  • Update processes
    • Improve Clinical Documentation (through Oct. 1)
    • Revise Paper Forms and Templates (April 1 deadline)
    • Modify Policies and Procedure (April 1 deadline)
  • Engage vendors and payers (Aug. 1 deadline)
    • Engage Technology Vendors and Update Systems
    • Engage Staffing/Billing Vendors and Evaluate Readiness
    • Engage Clearinghouses and Evaulate Readiness
    • Engage Payers and Evaluate Readiness
  • Testing
    • Prepare Internal Testing of Systems and Processes (Should be done by now)
    • Perform Internal Testing of Systems and Processes (Should be done by now)
    • Conduct External Testing with Partners (Aug. 1 deadline)

 We will tackle training next time.

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