Solutions Guide: ICD-10

According to a July 2011 HealthLeaders Intelligence Report, 60 percent of respondents expect the transition to ICD-10 to negatively impact cash flow. The No. 1 reason cited: incomplete physician documentation.

With 68,000 diagnosis codes and over 79,000 procedure codes, the ICD-10 code set is far more detailed and complex than ICD-9, which means accurate coding will require more thorough patient information. Successful ICD-10 implementation must begin with better documentation.

McKesson has identified five essential steps to help hospitals effectively engage physicians, support clinical documentation improvement requirements, maximize productivity and be fully prepared for a successful ICD-10 transition:

Step 1: Evaluate current documentation

McKesson recommends a three-step gap analysis to evaluate current readiness:

A. Determine the most frequent types of medical claims submitted.

B. Code samples of these claims in ICD-10.

C. Identify gaps in the supporting documentation.

Such an analysis might focus on the top 25 ICD-9 codes used and include a review of the group’s current documentation. If gaps are identified in only a few of the 25 areas, focus training on improving those areas. If gaps are discovered across the board, focus training on improving two or three each month instead of all areas simultaneously.

Step 2: Train physicians

The amount of training required will vary from one organization to another, depending on the type of medicine practiced. Physician education is done best in a face-to-face environment. The key is to provide personalized education so physicians can apply the appropriate level of detail based on their documentation. They do not need to be overwhelmed with details about the staggering scope and scale of ICD-10.

Step 3: Build a safe testing ground

Give physicians and coders a way to hone their skills – a safe testing ground. As the compliance deadline draws nearer, hospitals may benefit from a dual coding program that enables coders to practice in ICD-10 while generating claims in ICD-9. Such a program can be costly, but the right partner will help you keep costs in check and limit the need to increase staffing.

Step 4: Conduct ongoing audits

As physicians and coders make the transition, watch for a tendency to submit claims that include “unspecified” ICD-10 codes, which can trigger third-party audits. In-house monthly or quarterly audits provide immediate feedback about documentation and accuracy, and they identify areas where additional training may be required.

Step 5: Measure impact

Expenses will likely increase initially. Conducting a benefit-cost analysis helps hospitals and physicians account for the investments made and the amount of monetary gain realized. By measuring how clinical documentation improvements impact productivity, compliance and cash flow, hospitals are able to demonstrate the complete financial benefit to physicians and the organization.

SMALL PHYSICIAN OFFICES

Conversion costs ‘dramatically lower’ than estimated

Costs for small practices to convert to the ICD-10 coding scheme may be tens of thousands of dollars less than originally projected, according to new data published online in the Journal of AHIMA. The difference may be attributed, at least in part, to physicians and their office staffs doing more with less.

So how much less are we talking about? The article estimates that the ICD-10 conversion costs for a small practice are in the range of $1,900 to $5,900 – a far cry from the 2014 update of a widely referenced 2008 report by Nachimson Advisors to the American Medical Association (AMA), which estimated the cost for a small practice to implement ICD-10 was in the range of $22,560 to $105,506.

The authors of the November 2014 AHIMA article, “Cost of Converting Small Physician Practices to ICD-10 Much Lower than Reported” (Thomas C. Kravis, M.D.; Susan Belley, M. Ed, RHIA; Donna M. Smith, RHIA; and Richard F. Averill, M.S., 3M Health Information Systems), put together their estimates based on results from recent surveys, published reports and ICD-10 conversion experience with hospitals and physicians. A small practice was defined as three physicians and two impacted staff members (such as coders and/or office personnel).

The AHIMA article considered the costs for training, software upgrades, superbill conversion, end-to-end testing and productivity. Increased knowledge and readiness for ICD-10, combined with the availability of low-cost ICD-10 activities and resources, are cited as reasons for the new, lower estimates.

Reasons cited for the wide discrepancy between conversion costs include:

• Costs related to EHR adoption and other healthcare initiatives such as Meaningful Use are not directly related to the ICD-10 conversion and were sometimes included in previous estimates.
• Online clinical documentation and coding training can be purchased relatively cheaply for $50 to $300 for three hours of training in a particular specialty.
• ICD-10 diagnoses code books can be downloaded for free or purchased for between $70 and $300. An ICD-10 iPhone app for $1.99 is available with a word-search function to find an ICD-10 code.
• Many vendors are including the ICD-10 software update as part of their routine annual software update. Physician office costs are not expected to be charged for basic software services.
• For those physician offices that use a superbill (an itemized form reflecting rendered services), an ICD-10 superbill conversion is not substantially more involved than the current ICD-9 update process. AHIMA converted a primary superbill and reported that it can be done easily in less than a day.
• Since the primary responsibility for end-to-end testing is on the billing, electronic medical record (EMR) and clearinghouse vendors, physician participation is minimal.
• Previous estimates of additional documentation requirements and associated reduction in productivity were based not on studies of physicians’ offices but primarily on data from inpatient hospital documentation coding and billing activities and the potential risk of disruption in a hospital environment. Improved documentation is not simply an added cost, but can increase revenue for physicians.

Source: AHIMA

ICD-10 PREPRATION

How does your readiness stack up?

Findings from the Workgroup for Electronic Data Interchange (WEDI) August 2014 ICD-10 Industry Readiness Survey, the ninth in a series of such studies conducted since 2009, indicate that only about 35 percent of the 324 providers surveyed have begun external testing, while in the October 2013 survey about 60 percent had expected to begin testing by the middle of 2014. About 50 percent of the providers indicated they have completed their impact assessment, which is essentially the same number as in the October 2013 prior survey.

“The lack of progress by providers, in particular smaller ones, remains a cause for concern as we move toward the compliance deadline,” said Jim Daley, WEDI Chairman and ICD-10 Workgroup Co-Chair. “Delaying compliance efforts reduces the time available for adequate testing, increasing the chances of unanticipated impacts to production.”

Eighty-seven vendors and 103 health plans were also surveyed.

About 40 percent of vendors indicated they have completed product development, which is an improvement over the October 2013 survey, but more than 25 percent of vendors said that their products would not be ready until 2015 or responded “unknown.”

Health plans are the most on track. Nearly 75 percent of health plans had completed their impact assessment at the time of the survey. More than 50 percent said they have already begun external testing, a doubling of effort since the last survey (25 percent).

“It appears the delay has negatively impacted provider progress, causing two-thirds of provider respondents to slow down efforts or place them on hold,” wrote Daley in a September 24, 2014, letter to Health and Human Services (HHS) about the latest results. “While the delay provides more time for the transition to ICD-10, many organizations are not taking full advantage of this additional time.”

Source: WEDI

CONSULTING

Best in KLAS ICD-10 consultant rankings

* Rankings were calculated in January 2014 by KLAS. New rankings will be released at the end of January 2015.

SOLUTIONS

The 3M Coding and Reimbursement System Plus (CRS+) offers a dynamic user display with immediate access to DRG and reimbursement data, plus a 3M-hosted reporting tool. A patent-pending coder workflow combines 3M’s exclusive logic-based coding paths with an advanced ICD-10 table-driven design. The new look and feel helps coders   easily derive codes to simplify coding and improve productivity under ICD-10. Coders trained with the ICD-10 Procedure Coding System (ICD-10-PCS) code tables will quickly adapt to the familiar design and workflow, helping to improve the speed and accuracy of their ICD-10-PCS coding. 3M Health Information Systems

ASPYRA offers a wealth of services to help your laboratory make the transition to ICD-10. Preparation services include: generation of comparative Current Test Summary spreadsheets, entry of ICD-10 codes into CyberLAB tables, MNV validation testing and ICD-9 to ICD-10 mapping. A Scope of Effort Workshop provides a lab processing and billing assessment, while go-live readiness testing will ensure all functions and features of CyberLAB 7.3 are working as expected. ASPYRA

SSI has got you covered before and after October 1, 2015. The company’s 10Smart Solution provides smooth ICD-10 conversion and helps protect your financial picture during the transition to ICD-10. 10Smart includes: ClaimSmart Suite, a fourth-generation RCM solution; A/Rchitect, a breakthrough platform that features an Analytics Suite and ICD-10 Assessment Tool; and ClickON ClearView ICD-10, a claim-validation test harness. The SSI Group