ICD-10 Implementation: Are You Fit To Be The Champion?

Change always needs a champion.

Sometimes we get dragged into change clutching desperately to familiar habits.

Other times, a champion emerges to create some enthusiasm and expectation about a new and better way. ICD-10 is the new and better way. According to a number of industry experts, ICD-10 addresses critical gaps and operating flaws inherent in ICD-9. Further, ICD-10 will allow for the capture of the disease specificity, severity, laterality and better supports exchange of health data between other countries and the United States.

However, the coding change will affect almost every area of the medical practice from scheduling to cash flow. Successful implementation will require extensive planning and coordination so that the many details, such as staff education, contract renegotiation and documentation improvement, can go on without workflow disruption. Implementation is further complicated by the need to continue to use ICD-9 for non-HIPAA entities such as workers compensation and auto insurance. Despite many cautionary articles, many industry experts report that most practices do not yet understand the scope of next year’s transition to ICD-10.

“In the midst of running through our ICD-10 seminar content about creating project charters and communication processes, assessing current readiness, conducting impact and gap analysis, and developing an implementation plan, we realized that the doctors, though politely listening, were completely … not engaged. Our seminar leaders compared notes, and that’s when we had our epiphany. We realized it wasn’t pushback against ICD-10 that was causing this lack of connection; it was that most physicians don’t know the first thing about ICD-10. How can we talk to them about impact analyses, implementation planning and budgeting for staff training when they don’t know what ICD-10 really is?” said Denny Flint, President of Complete Practice Resources.

Flint has conducted hundreds of workshops on ICD-10 implementation and has designed a number of products designed to support the ICD-10 transition process. He says that billers and coders grasp how big the ICD-10 transition will be because of the attention given to the greatly increased number of codes. However, most practices have not done the impact analysis necessary to identify all area of practice impact. Some of the overlooked impact areas include scheduling, superbills, referrals, ancillary treatment coordination and denied claims follow-up. Further, some impact areas, such as staff training, vendor readiness assessment, payer negotiation and systems testing, may involve more oversight and time than initially thought.

Plus, most practices will likely maintain a normal patient and claim submission volume during the transition. However, most statistics predict that coder productivity will decrease by 20 percent as coders adjust to the new coding options and physician productivity is expected to drop between 10 to 20 percent due to the anticipated documentation queries.

On the training side, AHIMA estimates that coders and providers who must learn ICD-10-CM will need a total of 12 hours of training and four hours of practice coding. Coders who work in an acute care setting and utilize ICD-10-PCS will require around 50 hours of training.

Further, costs estimates published by RAND Corporation indicate that a five-physician practice may spend more than $166,000 over the course of three years. Cost estimates include expenditures for both a practice management system and an electronic medical record upgrade. While such expenditures may not apply to every office, CMS has recommended that practices have six month of financial operating capital in reserve for the transition period.

Based on these complexities, Flint says that the conversation on what needs done must start now. Educating doctors about ICD-10 benefits is critical because of the necessity for documentation improvement under ICD-10.

“We let them know gently that, despite the negative messages being spread by many, ICD-10 is not all bad and there exist real long-term benefits associated with it: fewer medical necessity denials, less wasted time and resources on requests for additional information, and the ability to create accurate, acuity-level databases with which the need for better reimbursement can be demonstrated. When physicians understand what is really important to know, right now – their role as the cornerstone of ICD-10 transition success, in terms of providing adequate documentation for coding purposes – the obstacles to implementation can be cleared.”

Flint says the big lesson learned from the many countries who have already implemented ICD-10 is that the earlier you start the transition process, the better. In most countries, ICD-10 transition has taken more time and staff involvement than initially anticipated.

Flint states that many offices may be seeing the recommendation that ICD-10 training for coders should be scheduled within six months of the ICD-10 implementation date of Oct. 1, 2014. While this timeline applies to coding training, practices would be well served by starting the documentation training as soon as possible.

Implementation experts agree that documentation-improvement training will benefit from this additional time due to the need for auditing current documentation for ICD-10 shortfalls, training on new documentation elements and review and enhancement to electronic medical record templates and prompts for ICD-10 compatibility. Coders may not have the extensive coding training that will follow but they can still begin to convert the practice’s high volume codes to ICD-10 and determine what documentation elements are necessary to bill those codes. Developing educational aides for providers such as flashcards and report cards can be developed to communicate with providers the added documentation detail required for ICD-10 coding.

Many resources are out there to begin including the following:

Complete Practice Resources ICD-10 website:

http://www.cpticdpros.com/blog/ – numerous implementation articles and conversion tips

http://www.cpticdpros.com/icd10-toolkit.html – ICD-10 transition toolkit is a task-driven virtual consultant with build-in audit functions for assessing documentation and generating provider report cards

CMS’s Implementaton Guide for Small And Medium Practices: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10SmallMediumPracticeHandbook.pdf

HealthStream’s ICD-10 Resource Library:


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