Are you ready for the ICD-10 transition? That’s the question most healthcare providers loathe, as the October 1st deadline nears and the potential for major problems and productivity loss grows. No one knows how many hiccups and headaches the more than 64,000 codes will create—but having the right products in place can help you prepare—according to E-MDs’ Mike Liter.
As Vice President of Account Management & Implementation at E-MDs, a leading provider in ambulatory electronic medical record (EMR) and practice management solutions, Liter provides insight as to how the right EMR/EHR solution can mitigate the inevitable growing pains providers will face with ICD-10 transition:
Q
Naturally, there are a lot of concerns coming our way with ICD-10 transition. It’s inevitable that it will slow down operational and care methods, affecting patient satisfaction and care quality. What do you see as the largest issues looming, especially in the areas of ambulatory services for providers?
The transition to ICD-10 is the biggest change to face our industry in decades. Essentially, everything associated with coding a patient encounter and submitting it for payment is going to have to change. And to your point about slowing down the ambulatory practice, productivity is likely to decrease across the board as physicians take more time to document the encounter and interventions, and coders travel up what is to be a very steep learning curve. There is the very real chance that a lot of software out there is simply going to break. Some staff may opt out of the whole transition, spurring an uptick in turnover. Everyone is expecting a significant spike in denials, as increased levels of specificity leads to more complexity in adjudicating a claim.
So, how do you survive the transition? Definitely start by not underestimating the degree of change required. And don’t skimp on training—train, train, train and then train some more. Docs will not be able to learn this on the fly. Coders will need to be re-certified. AR and billing people will need to understand the new coding schema to manage the follow up processes.
Attempting to wing this alone isn’t realistic. The best option for many practices will be to engage with a technology partner that has already invested in the tools, systems and training, and can provide a turnkey solution for transitioning to ICD-10.
Q
Keeping those very real problems in mind, your company’s perspective is that a health organization’s EHR can play a huge role in helping providers weather the storm that’s coming with the ICD-10 transition. How so? What makes this a realistic statement instead of a clever pitch for an EHR product developer?
Your EHR is probably the most important tool you have in the ICD-9 to ICD-10 transition. Since mapping from ICD-9 to ICD-10 will in most cases not be one-to-one, EHRs help guide providers to the appropriate ICD-10 diagnosis. There are a number of functions and features within the EHR to assure that users are selecting the most specific, billable, ICD-10 code for a particular diagnosis category. Some examples include:
– Templates that guide clinicians to the correct, specific ICD-10 codes
– Print and export functions to support medical necessity
– Coding crosswalks and dual coding tools to help choose the correct ICD-10 code
– An electronic superbill that’s more usable than a paper superbill
– Search tools to look up codes by diagnosis keyword, ICD-9, or ICD-10 codes to easily surface ICD-10 results
– Automated mapping to view ICD-9 and ICD-10 codes side-by-side
Q
So if the quality of a provider’s EHR product really plays a central role in mitigating some of those ICD-10 pains and strains, what should a provider look for to make sure that he/she has the best EHR for the tall task ahead?
Well, certainly verify the solution has the above capabilities. Along with that, there are a number of other questions it will be important to ask. The following are the most pertinent to identify an EHR that’s fully ready for ICD-10 and also supported by training and testing from a knowledgeable vendor.
When will your ICD-10 compliant system be ready? At this late date, if your EHR vendor cannot answer this question, you will not be ICD-10 ready. Hopefully, your vendor has been communicating its ICD-10 transition plan to you all along and has been guiding you through the phases to a successful transition.
Are there any additional costs involved for upgrades or ongoing maintenance? Some EHR vendors are issuing software upgrades, while others are producing an entirely new version of their products. Ask if you will be charged for the software updates, and how much. My feeling is that a true partner should consider it their job to make sure the system is compliant, and not charge clients any extra fees to complete this work.
What customer support and training will be provided? If your EHR partner is planning software updates, this means your staff will need training on new templates, layouts and processes. So that should be the minimum expectation for training on the product side. Additionally, ICD-10 will bring with it a whole new blitzkrieg of changes to workflow. Look for a vendor that will work with your practice to appropriately prepare your staff for the change. Online training programs, for example, allow staff to train on changes when and where they choose. Self-assessments are another useful training tool, and indicate where staff excel and where more attention is needed.
What is the basis of your crosswalk or mapping strategy? GEMs will be a useful crosswalk tool, but it won’t be enough. Only one quarter of the ICD-9 codes will have an exact match in ICD-10. The reality is that GEMs helps to ease the transition to ICD-10, but it is not the long term solution. In fact, there’s no one silver bullet. Training and education is a huge component of the ICD-10 migration. That said, a savvy EHR vendor will supplement GEMs with extended search capabilities. Natural language parsing allows users to use simple clinical keywords to find the appropriate code. “With,” “Without,” and “And” promote improved specificity.
SNOMED-CT can be mapped to ICD-9 and ICD-10. “My lists” and “Frequently Used” lists will need to be enhanced to include the ICD-10 code sets.
Be sure to ask if the system supports non-covered entities that don’t have to make the transition to ICD-10 immediately. Automatic code set selection, based on known payor readiness, is helpful here.
Will your product support dual coding? This is an important training tool. Dual coding allows medical coders to simultaneously use ICD-9 and ICD-10 codes in a chart to practice using the new system. Finally, dual coding also allows for testing with outside organizations, like payers and clearinghouses, to be sure that all systems are a go before they’re actually needed.
What is your external testing strategy? External testing is a critical part of the ICD-10 conversion process, and a key factor in assuring that revenue will continue to flow after the transition. Find out when and how your partner plans to test their products. Catching problems before they start affecting your bottom line will save you many headaches come transition time.
Q
What about employee training? How fundamental is it to have a premeditative training plan in place, and what should that training method or process look like? How can one make sure that the EHR product is up to snuff when it comes to assisting in that training?
e-MDs has been contacting every single customer and conducting a readiness assessment as part of our plan to help them with the transition. This also helps our clients understand the requirements.
We also have a comprehensive ICD-10 resource center for our customers they can refer to on demand. Tips, tricks, recorded training, and guidance documents on how to ease the transition, how to test, and other ICD-10 topics are always available at the online e-MDs Resource Center.
