Guest post by Mike Patel, CEO, Meditab Software.
As most healthcare professionals know, an important step in the improvement of healthcare quality and cost will take place in October 2014, just under a year from now. This important step is the transition from ICD-9 to ICD-10 – with this new code set, the largest financial system change will take place since the Prospective Payment System (PPS) in 1983.
This change has to take place for several reasons including that with a maximum of 13,000 codes, ICD-9 is not specific enough for detailed diagnoses and the current codes do not reflect new services and technology in CMS payment systems. With more than 171,000 codes, ICD-10 will provide much more detailed clinical pictures and data, improving accuracy in all aspects of patient care. New data available through ICD-10 will help determine public health needs and identify trends, as well as helping to spot bioterrorism and epidemics.
The transition will not only impact healthcare organizations, but also physicians, for whom it will be particularly beneficial. Physicians will be able to determine the severity of illnesses more clearly, and, therefore, quantify the level of care more accurately. The codes will also create an electronic trail of documentation, which can help physicians receive proper payment and ensure their reputation remains in good standing.
With the importance and significance of this transition, it is crucial that ample preparations are made. However, there are many organizations that have not yet embarked on the road to preparedness and many concerns exist throughout the industry. For example, according to a survey conducted by the MGMA-ACPME of 1,200 office-based practices surveyed, approximately 70 percent of respondents were very concerned about expected loss of clinician productivity and the same percentage was very concerned about changes to clinical documentation. 71 percent surveyed responded that, in order to accommodate ICD-10, their EHR systems either were upgraded or still need to be upgraded, will need to be replaced, or they are unsure which. Only 0.6 percent had tested their EHRs for ICD-10 compliance.
Undoubtedly, some healthcare providers will ask – is training really necessary? It absolutely is. To maintain their certifications, all medical coders must take a minimum number of ICD-10-specific CEUs before the compliance date. Each certifying organization determines the number of CEUs required. A follow-up question will most likely be – how much training does my staff need? It’s best to begin by conducting a gap analysis to determine the team’s knowledge of medical terminology, pharmacology, pathophysiology, anatomy and physiology. It is also important to review samples from different types of medical records to see whether the current level of documentation contains enough detail for ICD-10 coding. These initial steps will help determine a baseline for training needs.
While the training mostly focuses on the coding and billing staff, physicians have a learning curve too, as they will be required to provide more detailed documentation in visit notes to correlate with the new codes. Physicians with specialty-specific tools will be in the best position to make sure ICD-10 doesn’t have a negative impact on their revenue stream.
Below are some takeaway tips that all practices and physicians should keep in mind.
- Identify and plan to update all your systems to ICD-10 by making sure you understand your current systems and processes currently in use by ICD-9.
- Practices should make sure that all the modules such as EMR, billing and reporting components, have to be upgraded to accommodate ICD-10 changes
- Check with your IT vendor to determine if there will be hardware upgrade costs
- Participate in vendor’s webinar and training sessions to understand the impacts of ICD-10 in the existing system
- Communicate with your payers, clearinghouses and Meditab to determine their system readiness and ask questions about what they’re doing to prepare for the transition.
- Ask your payers if there are any contractual changes regarding coding specificity that could affect how you process claims.
- Document any potential workflow changes.
- Determine the training needs of your staff and aim to plan accordingly. Your staff will require different specific pieces of education around ICD-10 coding.
- Plan for added expenditures in time and resources as you work to prepare your practice and your staff for the transition period.
- The sources of expenditures include:
- Staff education and training
- Business process analysis of health plan contracts and documentation
- IT upgrade cost
- Increased documentation costs
- Practices should also be prepared for the possible cash flow disruption due to the ICD-10 transition. The disruption could exist until all healthcare entities successfully migrate to ICD-10.
- The sources of expenditures include:
- Test, Test, Test – Before the October 1, 2014 deadline, make sure to test your transaction submissions with your vendors, payers and clearinghouses to make sure everything is going smoothly.
For more information, please visit http://www.meditab.com/company/ICD-10-readiness/.
Mike Patel graduated from pharmacy school at the age of 20 and upon graduation, grew a pharmacy business to more than $16,000,000 utilizing technology and maximizing workflow. During the course of his pharmacy work he realized he wanted to help physicians improve their efficiency and so started the development of IMS in 1998. His vision was to design software for the healthcare arena to improve patient care and maximize efficiency.