Six ICD-10 readiness questions small practices need to answer

Wendy Aiken ADP AdvancedMD
Wendy Aiken, Product Manager, ADP AdvancedMD

According to findings from a 2014 Workgroup for Electronic Data Interchange survey, delaying the ICD-10 implementation date into 2015 was more of a detriment for small practices. They relaxed their efforts instead of using the time to further advance their plans, test and make changes they need to be compliant.

If you’re a small practice, it’s understandable how challenging it can be to even start thinking about what the forthcoming effect of ICD-10 will be on your business. After years of working with and talking to dedicated doctors, coders and office managers who keep the small practice running, I encourage you to just get started. Whether you’ve taken a few small steps or haven’t made any moves at all, arm yourself with these six key questions. Answer them and you will begin a process of learning through experience about how the shift to ICD-10 will affect your technology, people and processes. It’s also critical to understand is that unlike any other previous industry changes, the burden of readiness really does lie in the hands of the small practice.

#1 Have you started your ICD-10 process?

If you work for a small practice and haven’t started to prepare for the ICD-10 transition, it’s critical to know that the lion’s share of work to shift to ICD-10 is not something you can expect your software vendor to handle. Many vendors are working overtime to provide tools and resources to their customers, but it’s up to the small practice to use those tools. Preparedness for the transition to ICD-10 rests squarely on the shoulders of the small practice and getting engaged now will help a practice’s employees learn by doing.

#2 Do you have an ICD-10 implementation team leader?

Establishing someone in your practice to lead the team and drive and track process ensures the key pieces of being prepared for ICD-10 will be successful.  Every practice needs a leader to organize important pieces of preparedness like analyzing your ICD-9 codes and initiating the ICD-10 carrier testing process.  This person should have a good understanding of the office workflow and have the ability to make changes for the benefit of the practice.

#3 Do you have a clear understanding of the impact of your ICD-9 to ICD-10 analysis?

One of the most important parts of being prepared for ICD-10 is to understand how the most commonly used ICD-9 codes will translate into the ICD-10 code set. The changes can be eye-opening. For example, what used to be one code in ICD-9 may now translate into three ICD-10 codes starting in October. In more extreme cases, the ratio is one code to twenty or even hundreds. Understanding the impact of the increased code sets will bring additional implementation needs to the surface. Testing workflows, how patient clinical information is gathered and having a more detailed knowledge of anatomy may all come into play. The new ICD-10 codes will impact workflows, create training needs, affect productivity and may necessitate a change to the level of detail that is available in patient charts. Some practices may also need to consider getting additional outside coding assistance. Recognizing if your practice has these needs now is critical to acting as soon as possible.

#4 Have you performed chart audits of the high impact ICD-9 codes?

By walking through the process of auditing a chart, I’ve watched as the light comes on for people who work in small practices. Suddenly the impact ICD-10 will have on their business gets crystal clear. The need for detailed coding escalates using ICD-10 and that responsibility falls in the hands of billers and coders. Whoever is managing this aspect of a practice needs to have the proper background training and documentation to process an accurate claim quickly. Start by working through the process of helping the physician capture the important pieces of information. It can be as easy as updating the elements of the Electronic Chart Notes templates. This also helps uncover where staff doing the actual coding needs more training. Use the ICD-10 coding book during this exercise to help identify special coding needs.

#5 Have you participated in ICD-10 claims testing?

The opportunities for claims testing are few and far between, but they are critical to how your practice will fare starting October 1st. In fact, carrier testing opportunities will get increasingly rarer as the industry gets closer to October 1st date. The CMS has already conducted three test periods and is recommending July 31st be the end point for allowing testing; if that’s the future reality, then the window of time and availability is rapidly dwindling. Small practices need to act now.

Processing a full claim all the way through to the end will reveal where a practice has gaps. The End to End with remittance claims testing is the most helpful test a practice can conduct to understand how the ICD-10 coded claims will be paid. It will also demonstrate if staff knows how to use their ICD-10 application functionality. Testing also answers the questions:  Are my practice management and electronic health records software vendors ready and able to provide the ICD-10 functionality for a successful go live? Will my clearing house have the ability to successfully process a claim coded in ICD-10 through to the carrier? Will the carriers that have the highest impact on my practice be ready to receive and adjudicate my claims efficiently?

The lack of testing opportunities being provided to smaller practices right now is disappointing. Some practices will need to do some leg work to find ways to test with the carriers they use. Identify the top 25 payers and then filter that list into the top 10 carriers. Contact them to find out testing requirements and what their testing parameters are. It’s anticipated that claim denials will be a large part of the financial impact after the deadline date. By testing claims, you’ll discover technology related denials and errors well in advance and have the opportunity to fix them well before October.

#6 Have you started benchmarking important key performance indicators (KPIs) for post ICD-10 health?

Cash flow is part of doing business, but knowing where it can adversely affect your business requires a commitment to knowing your practice’s financial baseline prior to October 1, 2015. With those KPIs, you can compare things like your charge lag report immediately after the ICD-10 takes hold. Keeping a watch on these key metrics will help understand if things are going awry. For example, if your practice now has an average of a two-day response time, you can easily see how these changes come October. Identifying an increase in days early on will reveal where you need to make quick adjustments to prevent a cash flow problem. Standard KPIs to have a baseline understanding of now include: your denial statistic, increase in days for accounts receivable from top paying carriers, increased amounts of claims editing for diagnostic and procedural codes, and reimbursement analysis.

Get started by finding the most commonly used ICD-9 codes for a procedure codes or groups of codes that you use often and set up KPIs around these. Practices should identify the most commonly used ICD-9 codes as well as the most common types of procedure or groups of codes. Then set up KPIs around these. For example, a dermatology office might have a commonly used ICD-9 code with several different procedure code set scenarios around it. These examples can be used to monitor any changes in the baseline numbers. With a clear understanding of the practice’s financial health now, better insights into the processes will help improve the cash flow prior to ICD-10.

It isn’t really a question of where a practice gets started preparing for ICD-10, only that the effort start. One practice I spoke with recently admitted that after looking through the ICD-10 book, she was able to see the potential impact of the change. Get started digging in, reading and asking questions in order to move to the next steps. Answering those questions will help the rest will fall into place. Do take advantage of the many forums, webinars and publications to help your practice find additional relevant questions and get clarity on this large important process. The health of your business depends on it.

ADP AdvancedMD, claims testing, key performance indicator, KPI, WEDI, Workgroup for Electronic Data Interchange


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