Physical therapy services

Preparing to Weather the Storm of ICD-10

by Nitin Chhoda PT, DPT | Jul 20, 2015 | Electronic Medical Records, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

There’s much to do before the mandatory transition to ICD-10 codes and little time to accomplish a mountain of tasks. Much of the ICD-10 code preparation plan enacted by clinicians will depend upon the size of their practice.

The deadline is Oct. 1, 2014 for the exclusive use of the new codes and it’s very unlikely that clinicians will receive another reprieve in the form of a nationwide delay.

Where To Find Help

Before an implementation strategy can be created, it’s essential to know what resources are available that can provide assistance.

The Centers for Medicare and Medicaid Services is a primary resource and has a multitude of data for different sized practices and facilities.

EMR vendors, coding/billing software vendors, and the American Health Information Management Association can also prove helpful.

Creating A Strategic Planning Team

Few practitioners have enough time in the day to treat patients and become ICD-10 experts. Creating a project team will free clinicians to conduct the daily business of the practice and allow them to obtain essential facts upon which to make informed decisions.

Budgeting and Planning

Implementation will affect practices in a variety of ways that includes software upgrades, purchasing hardware and manuals, and obtaining staff training.

The project team should take no more than two months to provide clinicians with the needed data to develop a realistic budget and secure appropriate funding for needed changes, based upon a comprehensive audit of the clinic’s current systems.

Communication Between Staff and with Vendors is Critical

Communication is a key ingredient in ICD-10 preparation and it will be an ongoing process. Practitioners will need to inform staff about the changes, how it will affect them, and establish a training schedule that doesn’t interfere with the operation of the practice.

Communication extends to all the vendors, payers and clearinghouses with which the practice interacts. Find out when their systems will be in place and when testing can begin.

Glitches in the system can’t be avoided, making it imperative for clinicians to monitor other entities to determine their readiness, ensure software systems are compatible and perform testing.

Testing Your Level of Preparation for ICD-10

There will be multiple tests prior to the 2014 deadline. Systems will need to be tested to determine if claims can be submitted, and if documentation can be completed accurately and efficiently. Staff will need to be proficient in their understanding of the new codes and the ways it will affect them.

Documentation And Coding Principles May Need Modification

The forms and documents a practice currently uses may need significant changes or modification, or new templates may need to be created to facilitate the documentation and coding process.

Billers and coders will need in-depth training and extensive practice in the practical application of the codes to avoid claim rejections.

They will also need sufficient time to work with any changes in the forms they use to gain proficiency.

Even with the best laid plans, practitioners should be prepared for glitches, errors and last minute changes among the entities with which they routinely communicate.

The change to ICD-10 codes represents major changes in the way clinicians document their patients’ complaints, along with the software and systems they use to do so.

Being prepared for potential problems doesn’t mean practitioners are pessimistic. It demonstrates a realistic and responsible attitude that will help practices weather the ICD-10 storm.

Five Ways to Minimize Financial Havoc with ICD-10 Transition

by Nitin Chhoda PT, DPT | Jul 16, 2015 | Electronic Medical Records, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

The implementation of ICD-10 codes will have a financial impact on all practices. Practitioners will need to prepare for situations ranging from software errors that prevent reimbursements to the cost of staff training.

This requires a strategic plan that addresses the potential for multiple problems that will directly affect a clinic’s financially security and well-being.

Maintain Cash Reserves – Plan Ahead

A practice’s cash flow depends on coders/billers obtaining the best turnaround times on claims and that may not happen in the early months of ICD-10 implementation.

The reimbursement process will undoubtedly experience slow-downs and clinicians would do well to have sufficient cash reserves on hand to pay the bills and staff during the growing pains the new system is sure to suffer.

It’s best to acquire a business line of credit or a business credit card with a 0% APR for six to nine months to help tide over the first few months after ICD-10 is enforced.

Training And Education Essentials – Invest in Resources

Some practice owners will be fortunate to have staff training provided by vendors. Those who aren’t will be required to locate competent contractors who can provide the specialized training and education required for the implementation.

Everyone within the practice will require training. This includes the billers/coders as well as clinicians, who will need to modify clinical documentation to justify the increased specificity with the ICD-10 coding system.

Without enough training, bills will keep coming back to practitioners to fix, which will delay the entire payment process.

In-House Or Outsourced Billing – Examine Pros and Cons

Practitioners who are considering outsourcing will want to weigh the costs of training for in-house services against hiring an outside firm to handle those duties.

Coders/billers will need substantial training to minimize the disruption of reimbursements.

Experienced billers/coders are already in short supply and it may be better for the practice financially to hire a specialist who has already undergone training.

The Impact Of Security Vulnerabilities – Protect Data

Maintaining security is a very real concern, especially with the array of potential problems surrounding the transition.

Ensuring the security of patient information may include the purchase and installation of security software, while others may incur additional costs from vendors who are responsible for the system’s integrity.

Mistakes, oversights or compliance issues can cost a practice dearly.

Prepare for the Threat Of RAC Audits – Maintain Compliant Documentation

No one wants to hear that they’re the target of a Recovery Audit Contractor (RAC). ICD-10 implementation errors could appear as an attempt at fraud or abuse, causing a stain on a clinician’s reputation and disruption of the practice’s operation.

The best way for a clinic to be prepared is for the clinician to improve their documentation standards with the increased specificity that is necessary to justify the use of the new ICD-10 codes.

A RAC intervention is a lengthy and costly process for a private practice owner. In fact, it has the potential to drive a practice out of business.

The implementation of ICD-10 coding will take a financial toll on practices of all sizes. Preparing for the transition requires that clinicians use all their deductive skills to identify areas where the coding change will have a financial effect and plan for every contingency.

Three Biggest Mistakes to Avoid with the ICD-10 Transition

by Nitin Chhoda PT, DPT | Jul 13, 2015 | Healthcare Practice Management, Medical Billing, Physical Therapy Billing, Physical Therapy Management

Dramatic Decrease in Productivity

When Canada implemented ICD-10 codes, it was only a fraction of what the U.S. plans to add on October 1, 2014.

The problem – productivity among physicians and billers/coders never returned to pre-implementation levels.

The American Academy of Professional Coders predicts the same for U.S.

The organization indicated that the sheer number of codes, combined with the new and unfamiliar alpha-numeric code combinations, could reduce productivity by up to 50 percent.

That translates into reduced reimbursements and greater turnaround times on claims.

The first few months of implementation will be a critical time for practices financially as they deal with inevitable errors that mistakenly deny claims and requiring multiple resubmissions, further slowing down the system and cash flow.

Insufficient Billers/Coders

Experienced billers and coders are in short demand and those with in-depth knowledge of ICD-10 codes are even fewer.

Practices may find that those with expertise are taking employment as trainers and consultants, further narrowing the pool of ICD-10 specialists available to work in practices.

The lack of billers/coders familiar with ICD-10 codes will slowly increase as more are trained, but the shortage doesn’t bode well for practice owners trying to maintain their cash flow.

Complacency (The Notion that ‘It Will Get Delayed’)

Many practice owners aren’t moving as quickly as they should and preparing sufficiently for the coding transition, out of a sense of complacency.

Some are hoping another delay in implementation will buy them more time, while others either aren’t sure where to begin or view it as a simple software upgrade.

Some see the coding change as an inconvenience, and not one that’s a high priority.

The Centers for Medicare and Medicaid Services has indicated there will be no more delays and the implementation will occur on Oct. 1, 2014 as planned. The organization has an extensive array of data, resources and timelines to assist practices prepare.

Clinicians that aren’t ready on implementation day will face severe consequences. Any claims with a date of service after October 1, 2014 without ICD-10 codes will automatically be denied.

The ICD-10 transition will affect every practice.

Extensive training for staff, electronic medical record software upgrades and hardware systems will be required.

The procedure will place added stress on staff, disrupt normal office procedures, and affect the financial health of clinics.

Procrastination won’t make the ICD-10 transition go away and it’s far better for practices that prepare for the deadline over time instead of waiting until the last minute and hoping for the best.

Clinicians that don’t prepare their practices will suffer from reduced productivity and the inability to collect on reimbursement claims.

The ICD 10 Countdown for Your Private Practice

by Nitin Chhoda PT, DPT | Jul 9, 2015 | Electronic Medical Records, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

The transition to ICD-10 codes is the most significant change in 30 years and many clinicians still don’t realize that without the new codes, all their claims will be rejected after Oct. 1, 2014.

The deadline for implementation won’t be pushed back again.

Practitioners need to prepare now and establish a timeline to give themselves adequate time for staff training, to update/upgrade systems and conduct testing.

Conduct an Impact Analysis

The code transition will impact systems and people in multiple ways.

Clinicians will need to conduct an impact analysis to determine how extensively implementation will affect both manual and electronic systems.

The American Medical Association has indicated that the process of updating clinician and vendor systems will take up to six months.

Finding a Vendor

Practitioners will need to contact vendors to ascertain costs and how quickly implementation of new software and hardware can be completed.

It’s essential to find a vendor that supports staff training and maintains responsibility for updates/upgrades, while minimizing costs.

Clinicians may find they need to locate a new vendor to meet their needs.

Communication Is Key

No practice stands alone and clinicians will need to communicate with one another, their biller or billing service, vendor, clearinghouses and insurance companies to ensure systems are compatible.

Extensive system testing will be required between all the entities involved and will take two to three months to complete.

Custom Templates and Modifications

Clinicians should begin now to familiarize themselves and staff with the new codes. Documentation may need modification to reflect coding changes, create claims and accommodate data collection methods.

Don’t use cookie cutter templates – create customized templates that are relevant to the practice.

An EMR and billing software that provide crosswalks between ICD-9 and ICD-10 codes are critical.

Training for Success

Staff training will take two to three months.

A training schedule will need to be created that provides every staff member with a working knowledge of the codes and how they will affect their duties, but one that minimizes the effects on daily operations.

Training exercises using the new codes is good practice for the implementation deadline.

The transition to ICD-10 codes can’t happen overnight. It takes extensive planning and communication between all the parties involved. ICD-10 isn’t a catastrophe, but getting caught unprepared will be catastrophic for the survival of practices. One break in the chain anywhere along the line and clinicians won’t be paid.

Preparing for the ICD-10 Transition

by Nitin Chhoda PT, DPT | Jul 6, 2015 | Electronic Medical Records, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

Many clinicians describe the change to ICD-10 codes as exciting, but others use words that include scary and expensive. Training in the use of the new codes will be required for many employees, especially for coders/billers, which has many in the profession viewing the transition with trepidation.

The American Health Information Management System (AHIMA) has determined that it will require about 16 hours and $500 to fully train coders working in a small practice who are already experienced in ICD-9 protocols.

The training expands to 57-62 hours for all others. AHIMA indicated that most coders should receive their training three to six months prior to ICD-10 implementation so the information remains fresh in their mind.

More Codes For All

ICD-10 contains 141,000 alpha-numeric codes, but all practices won’t use the full complement of codes.

General physicians may use 30 more, while rheumatologists and orthopedic surgeons may use up to 60 percent of the new codes. ICD-10-CM codes are used for a diagnosis and description of symptoms.

ICD-10-PCS codes are those that will be used to describe procedures, but only in the U.S. for inpatient hospital environments.

Easing The Transition

Using an EMR and computer assisted coding will significantly reduce problems. EMRs are capable of handling all the new codes. Additionally, some systems identify potential problems and notify billers/coders before the claim leaves the office for reduced denials.

The systems still rely on human operators and will help alleviate an expected reduction in productivity the new codes will engender.

One problem that many have overlooked is a decrease in morale associated with the transition. Many coders/billers are anxious and nervous about the new coding.

Their primary worry is being able to maintain the expected cash flow to practices. It’s a legitimate concern and one that clinicians and billing specialists will need to work on together.

Training Opportunities

The Centers for Medicare and Medicaid Services, the World Health Organization, professional billing/coder organizations, and some insurance providers have developed training modules and tools to assist individuals in their quest for reliable training options.

Coders are the professionals that bridge the gap between clinicians and insurance companies to ensure practitioners get paid.

One of the biggest problems facing billers/coders is finding the time to learn ICD-10 coding while maintaining their normal work day with ICD-9 coding.

Online education is a convenient remedy that can be a cost effective solution for practices.

Plan For Contingencies

The best way to learn is by doing and professional coder/biller organizations highly recommend that anyone who will be working with the new codes conduct simulations using actual claims.

The exercise provides practical experience and helps familiarize coders/billers with codes before the official rollout.

Clinicians need to establish a crisis committee to formulate a backup plan to accommodate slow-downs in reimbursements during the first few months.

The U.S. is one of the last countries to adopt the ICD-10 coding and it’s coming at a time when many practices are still involved in meeting meaningful use standards and changes associated with Obamacare.

When Canada implemented ICD-10 codes in the 2000s, productivity was sharply reduced for months and the same is expected for the U.S., but many problems will be greatly alleviated through appropriate planning.

Making the Case for ICD-10 Codes

by Nitin Chhoda PT, DPT | Jul 3, 2015 | Electronic Medical Records, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

ICD-9 codes were originally designed as a classification system to compile statistics, but as a code set, ICD-9 does not provide the information that payers desire for reimbursements or the type of data needed to monitor situations that include disease outbreaks by entities like the Centers for Disease Control (CDC) or the World Health Organization (WHO). In other words, it is now an outdated code set.

Implementation of the new International Classification of Diseases is mandatory and there are a number of compelling reasons for the transition, from patient management to identifying and addressing potential pandemics.

The codes were developed by the health division of the United Nations and the U.S. is one of the last countries to implement the codes, a move that has been criticized by other nations.

Codes For A New Era

The ICD-9 system is running out of number combinations to adequately describe new diseases and illnesses, terminology and technological advances since its implementation in 1979. The ICD-10 codes employ an alpha-numeric diagnosis and procedural system that’s more specific.

ICD-10 is designed for significantly more specificity and accuracy, which can increase the amount of documentation required for reimbursements.

The new system offers the ability to code for new diseases, techniques and procedures as they emerge in coming years.

Identifying Fraud, Trends And Abuse

The new codes provide additional oversight for payers, allowing them to identify instances of fraud, trends among practitioners, and individuals who are abusing the system.

It’s a tool that insurance companies have indicated can be used to significantly reduce the cost of healthcare.

Grading Performance

Utilization of ICD-10 codes allows payers and professional organizations to monitor how clinicians are utilizing available resources in an effort to provide better patient care and effective management to reduce overall costs.

The new codes provide payers and government officials with a means to grade the individual performance of medical providers and facilities, establish reimbursement rates and set public health policies.

Improved Analytics For Practitioners

The new codes offer analytic tools for clinicians, allowing them to track patient illness, injury and disease trends.

Clinicians will have enhanced tools to monitor instances of everything from cancer and domestic abuse to diabetes and obesity rates.

Practitioners have no choice but to transition to ICD-10. Modifying patient records to reflect the new codes will require a significant investment of time and effort, but many medical professionals are looking forward to a change that has the potential to improve patient care.