Q
There are some providers who feel they are arriving late in the game to tackle the transition. For them, this is more than a monumental task. What do you say to those who are just starting to think about tackling the ICD-10 transition? Is it too late for them to mitigate the productivity loss that’s coming?
It’s not too late, but the clock is ticking. An impact assessment is the single most important task in your ICD-10 transition. Understanding all the areas and people that will be impacted will help you understand the work at hand and how to budget time and resources appropriately. You will be more likely to cover all your bases if you start out in a very organized way and break it up step-by-step.
Your impact assessment should evaluate how ICD-10 will affect:
– Business practices
– Documentation changes
– Reimbursement
– Systems and vendor contracts
ICD-10 will affect nearly all areas of your practice, but with a thorough impact assessment, you can keep your day-to-day activities running smoothly while you make the transition.
Q
We have learned a few things from other countries’ ICD-10 transition, including Canada’s. What we learned from their approach is to not only understand the importance of coder training, but also really understand where your organization stands in terms of operational productivity, billing, and even clinical documentation practices. Are these all areas where a good EHR can provide robust assistance? Because as we move toward a shift of value-based care, the consensus is that an EHR cannot do it all. What do you say to those claims?
It’s true, an EHR alone won’t cut it. You need a vendor that provides a full suite of services addressing your clinical, financial and administrative needs. This means an integrated system that offers EHR, PM and RCM services. Circling back to the expected rise in denials as claims get more complex to adjudicate, while your EHR can be enormously helpful in making sure codes are correct, there a number of RCM tools that can assist in navigating the myriad of additional Local and National Coverage Determinations increasing the likelihood of a clean claim. These included automated claims editing, which scans and flags for errors before submitting a claim; automated patient eligibility verification; authorization verification, to name a few. A vendor that can provide all of these services can also integrate them seamlessly into the EHR.
Q
What should providers anticipate in the few months post ICD-10 and how can they mitigate these risks?
In the first few months post ICD-10, patients are likely to see:
– Intake delays from the new documentation required for ICD-10
– Denials of benefits due to inaccurate coding
– Erroneous coding due to data entry mistakes
– Registration or scheduling delays
To mitigate these risks, processes and procedures related to patient registration, intake, and discharge must be thoroughly reviewed and upgraded. In addition, front-office staff will need basic training in ICD-10-CM and ICD-10-PCS.
Longer term, ICD-10 is critical in order to move forward with value-based models, not to mention the anticipated benefits from more accurate payments, improved disease management, surveillance of pandemic threats, and the ability to reduce complications of care by more accurately identifying the factors and circumstances surrounding a patient and to accommodate new treatments and technologies such as minimally invasive surgery that have made ICD- 9 obsolete. Ultimately, the patient benefits from these changes.
Q
How important will automated patient outreach and engagement features be when we talk about the transition to value-based care? Again, won’t providers have to add more sophisticated software to serve their population health management (PHM) goals, overshadowing the functionality of their existing EHRs and diminishing the importance of such products?
We are entering an unprecedented collaborative era in healthcare, from ACO care delivery models to Big Health Data projects with numerous stakeholders. Today, healthcare organizations of all sizes must be able to exchange electronic data. Look for an EHR with proven and successful interfaces with major e-prescribing companies, diagnostic labs, HIEs and other healthcare entities.
Q
We’ve covered a wide array of what’s to be expected with the ICD-10 transition. What’s the one consideration providers are overlooking that you think needs more attention?
Again, training. Mastering the complexity and granularity of ICD-10 will require a tremendous amount of preparation and practice. And yes, physicians will require extensive training too. Even if they don’t input the final coding of the encounter, they will need to understand the new documentation requirements.
Some considerations of the training plan:
– Physicians and coders will require the most time
– Local or distance options are available (boot camps, conferences, online training, webinars)
– You will likely need to add resources during the training process – temporary help or overtime
– Make sure training materials are available to your staff
Starting now will help bridge the gap in the shortened window prior to transition.
Q
Lastly, what’s the key takeaway here, as we approach the deadline for ICD-10 transition? If there is one thing to keep in mind as the deadline nears, what is it?
As hard as it is, try to plan for the unforeseen issues and those issues you have no control over. Even with adequate training this is a completely new dynamic. Systems are new, processes are new, etc. Productivity is likely to decline which will result in reduces claims going out and subsequently less consistent cash flow. As well, payors are transitioning to the new code set parallel to the providers and there is no way to foresee processing delays that could slow cash flow. Practices should work to stabilize as much days cash on hand to assist during the transition and potential payment delays.