Preparing to Weather the Storm of ICD-10

Preparing to Weather the Storm of ICD-10

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.

ICD 10 codesWhere 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.

ICD 10 codesThey 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.

Three Biggest Mistakes to Avoid with the ICD-10 Transition

Three Biggest Mistakes to Avoid with the ICD-10 Transition

ICD 10 codesDramatic 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.

ICD 10 codesClinicians 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.

Preparing for the ICD-10 Transition

Preparing for the ICD-10 Transition

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.

ICD 10 codesThe 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.

ICD 10 codesPlan 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

Making the Case for ICD-10 Codes

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.

ICD 10 codesImplementation 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.

ICD 10 codesThe 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.

Codes: A Fast Guide to the Medical Codes ICD-9 System

Codes: A Fast Guide to the Medical Codes ICD-9 System

A patient calls it a sore throat, a doctor calls it pharyngitis and healthcare insurance calls it a 462. Each is accurate, but if the correct ICD-9 code isn’t entered or doesn’t match the diagnosis, the physician won’t be paid for his services.

Designating the right ICD-9 codes is essential to collect reimbursement claims and Nitin Chhoda offers a crash course in the coding system.

codesICD-9 codes are the internationally recognized three- to five-digit numerical designations for each condition and disease.

The codes are organized into three categories known as volumes that are used by medical professionals across the nation for billing purposes when submitting reimbursements claims.

Medical Codes Development

Developed by the World Health Organization, the system is comprised of volume 1, a compendium of diagnosis codes for diseases and conditions.

Volume 2, arranged in alphabetical order, provides an index to diagnostic procedures and volume 3 lists procedure codes. The system is set to be updated in Oct. 2014 to the new ICD-10 codes.

The new system reflects advances in medical terminology and technology, and enables practitioners to provide more detailed information to insurance companies. Early preparation for the switch is advised, as those in the medical profession are anticipating some disruptions during the transition.

The Coding System

The ICD system links a diagnosis with a procedure for billing purposes. The codes tell insurance companies why the client met with the clinician, the diagnosis, and procedure or treatment that was provided to return the patient to health. The codes are further broken down into subcategories and sub-classifications.

ICD-9 codes offer provisions for making a multiple diagnosis, which can also be entered in an electronic medical records system. The first diagnosis code is used to explain the reason the client was seeking care. Other conditions may be observed during the examination or be part of the patient’s medical history.

Those are placed second and third on claim forms as contributing factors, already existing conditions and complications, providing a source of supporting evidence.

Medical professionals must also be cognizant of the abbreviations, punctuation and symbols used within the codes, known as conventions.

Proper Coding is Essential

It’s critical that the proper coding is entered on reimbursement requests and that a practice’s billing and coding specialist is well versed in their craft. Codes that don’t match the diagnosis or procedures taken will be delayed, denied or questioned as to the medical necessity of the action taken. Even simple mistakes will severely interrupt a clinic’s cash flow.

Don’t Judge an EMR by the Cost of its Software

Don’t Judge an EMR by the Cost of its Software

Many physical therapists find that using physical therapy EMR is expensive. However, Nitin Chhoda emphasizes the many benefits of EMR systems and how the initial expenses can be justified with the long term savings down the road.

EMRPatients and practitioners are living in an exciting age of technological advances that detects diseases earlier and saves lives, but the ability comes with an impressive price tag.

That cost extends into the office with EMR technology and it’s an expense for which many medical professionals aren’t prepared.

The cost of implementing an integrated EMR varies widely, dependent upon the type of system that is utilized.

Practice owners can choose to install an on-site system that they must service themselves, or choose a vendor-maintained package that comes with a monthly fee. Free EMR systems are available, along with those with price tags of up to $80,000. It’s a major expense for any size clinic, but can be devastating for smaller practices on a budget.

EMRs should address the basics

An EMR should speak to three primary functions in the office environment. It should allow practice owners to submit reimbursement claims online to expedite cash flow, provide complete patient documentation, and maintain a client health record that enables clinicians to deliver a superior level of care.

An EMR encompasses of host of functionalities for marketing, client communications and collections, but should address the essentials first.

Cost doesn’t always mean quality

There’s no guarantee that an $80,000 EMR system will perform any better or offer more sophisticated abilities than one that’s free. EMR vendors offer valuable services and resources, but clinicians should remain cognizant that the ultimate goal of such firms is to make money. It’s impossible for a one-size-fits-all system to accommodate the needs of every type of healthcare facility. There will be gaps and inconsistencies that will adversely affect a clinic’s revenues.

Don’t forget the hardware

Implementing an EMR requires hardware, whether it’s hosted by a vendor or housed on-site. For vendor supplied installs, the web-based functions will be maintained on the company’s servers, but clinics will need to purchase laptops or tablets to access the EMR, along with routers, cables, servers and terminals. The cost is much more extensive for practice-maintained electronic medical records housed on-site.

The high cost of tech support and maintenance

Technical support is essential to ensure the smooth running of an intricate EMR system. Clinicians should determine the full extent of the available support before committing themselves and their livelihoods to a nebulous promise. Tech assistance should be available around the clock and include experts that will come to the clinic if needed.

Learning to use the system in easy steps

electronic medical recordsStaff training can represent a significant financial outlay if employees must travel or miss work to learn the system’s operation.

Many vendors offer on-site and online training as part of their services, but the real cost to clinics will demonstrate itself through an initial loss of productivity and interruption of the normal workflow.

The costs associated with implementing an integrated EMR are varied and they’re expenses that most clinic owners don’t even consider. They look only at the initial cost of the software, without considering the implications of staff training, hardware and IT professionals.

There are many expenses that may not be immediately obvious, but they’re elements that will cost clinics dearly in revenues if they’re not settled before implementation.