In June 2012, the MGMA-ACMPE released the results of a questionnaire that ranked members' most pressing practice management challenges. In this edition of “Practice Makes Perfect,” we'll tackle No. 3 on that list: preparing for the transition to ICD-10 diagnosis coding.
Create an ICD-10 implementation team
When creating this team, it is best to identify one or more physicians to participate to secure executive buy-in and act as liaisons with the other physicians in the practice. In addition, consider adding representatives from areas such as nursing, ancillary services, billing and finance, information systems, reporting, coding and health information management. Conduct an internal assessment
Each member of the practice implementation team should catalog how ICD-10 will impact their particular area of the organization. In particular, it is critical to identify what software in the practice will need to be upgraded or replaced. This may include the EHR decision-support and reporting systems; the practice management system (billing and claims); utilization management and case-mix systems; disease management systems; provider profiling and performance measurement systems; and medical necessity software. Document organizational workflows
Determining how patient encounter documentation is recorded, reviewed and coded is an important step in the assessment process. (Larger organizations may require the services of consultants to assist them in identifying current workflows and their potential redesign.) Finally, the implementation team should also determine which staff members will require education and training in ICD-10. Typically, staff can be divided into those who require comprehensive training, those who require midlevel training and those who require minimal training.Conduct an external assessment
Once your implementation team has established what systems in the practice and what staff will be impacted by ICD-10, the next step is to conduct an assessment of your external trading partners. This process should include first reviewing current trading partner agreements to ascertain, for example, whether software upgrades to accommodate ICD-10 are included in maintenance contracts. A letter to each vendor should request the following information:
- What is your schedule for ICD-10 software upgrades/training? Get it in writing!
- Will you be upgrading my version of the software?
- Where applicable, what is your software interface solution to my EHR/practice management system?
- With the upgrade/replacement of my software, will I require additional computer hardware?
Request a timeline from your clearinghouse and major health plans detailing when they will complete their implementation and when they will begin accepting test transactions. Also find out whether your clearinghouse and health plans are offering educational and training resources that you can take advantage of. Should the practice outsource billing and coding functions, these firms or individuals should be contacted to determine if and when they will be ready for ICD-10.
Should any of these trading partners not provide you with adequate assurance of their readiness, use this extra time to identify alternative firms, individuals or options for your practice. Establish a preliminary budget
Transitioning your practice to ICD-10 will not come without expenses. There are a number of initial cost drivers, including staff education, code set training and software upgrades. While other costs are likely later in the implementation process, creating a preliminary budget early and having it approved by senior management will help jump-start your ICD-10 activities.
In addition, should your assessment indicate that the practice will likely incur significant expenses, it is best to share this with senior management well in advance as they determine future practice plans and budgets.
for additional ICD-10 information and checklists.
Though the move to ICD-10 will be quite challenging for practices, by taking these initial low-cost steps, you'll improve your chances of having an efficient transition.
Senior policy adviser
MGMA Government Affairs Department