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Six Must-Dos to Increase Your ICD-10 Confidence
By Wendy Aiken, PMI-ACP

If you have a small, independent medical practice, you're likely concerned about the looming ICD-10 deadline. You have a lot to do already: run a business, see patients, keep charts up to date, surgeries, rounds, continuing education, and trying to have a personal life, among many other things. With all this in mind, you might be secretly hoping ICD-10 will be delayed.

Well, in case ICD-10 isn't delayed, which it most likely won't be, are you prepared? Is your staff trained and ready? If you are not quite sure what to do to prepare or even start, here are six survival tips. Become more confident with ICD-10 and move forward. It's not too difficult. The success of your transition to ICD-10 is not so much about the means or method by which you accomplish it, but in understanding the value in just doing it.

1. It's much easier to become familiar with ICD-10, and ultimately become ICD-10 compliant, with a trusted partner. Even though a partner will make it much easier, you still need to work the process each day and understand your specific circumstances. Your work now will give you the much-needed confidence when that day arrives. Dig in and move forward a little at a time.

2. Understand how your top ICD-9 codes will map into the ICD-10 code set. This will help you estimate how much the codes will affect your independent practice. Understanding the impact of the increased code sets will bring additional implementation needs to the surface. The following are needs you may come across:

• You may uncover the need of charge slip and workflow evaluations. If you use a paper charge slip, for example, when printed, the ICD-10 codes will most likely turn it into a large number of pages. What should you do going forward? Should you change to an online charge slip, or are there other ways to continue with paper charge slips? We all understand the connection most physicians have with their charge slips, so switching to this new process early is important.

• You may find a need for chart auditing. If your top five codes explode into lots of ICD-10 codes, you will need to make sure documentation is being captured to attain that level of specificity. Ensuring accurate and complete clinical documentation is being captured now will help lessen the productivity impact expected come October.

• Lastly, understanding the new codes may help identify the impact of your coding process and charge posting process. Who is doing coding now, and do they need training? Do you have the resources to accommodate a loss of productivity? Do you have a holistic view of the charge process and understand how the new ICD-10 constraints will affect each member of your staff?

3. The new ICD-10 codes will require chart auditing prior to the implementation date. Practices will most likely need to consider getting additional outside coding assistance. Auditing could uncover impacted factors such as workflow, training, and productivity. It also allows you to assess the need to change current processes to capture appropriate detail in the clinical note; this may necessitate a change to the level of detail available in patient charts. Walking through the process of auditing a chart will identify places that need adjustment before time runs out.

For instance, assessing the template in your EHR to ensure the right elements are there to capture the needed clinical information will help you without requiring much extra work. This can also show where the coding staff needs more training. If a qualified coder has a complete chart containing all the information in front of them and they still can't get to the required level of specificity, what is my next action? Is training needed, and, if so, what kind? Do I need to find outside coding resources?

4. Testing claims now is critical to giving you the confidence that your current vendor, clearinghouse, and carriers are compliant. Unfortunately, testing opportunities are difficult to find right now. It's important to look at your top carriers that comprise 70% to 80% of your revenue and ask them if they can offer assistance with testing opportunities. Completing this process quickly and early will help you understand what ICD-10 will look like for your practice on October 1. At this point, it's all about practice workflow and testing, so test, test, test.

5. You need to know and understand your key performance indicators so you can compare factors when ICD-10 takes place. An example is your charge lag report; if your practice currently averages a two-day response time, you can easily imagine how this may change in October. Recognizing an increase in response time early on will reveal where you need to make quick adjustments to prevent any concerns with cash flow. Practices should identify the most commonly used ICD-9 codes as well as the most common types of procedure or groups of codes. Then set key performance indicators around these metrics. Many practices that are doing this now are finding improvements to their process and receiving better cash flow. Taking these actions now will greatly lessen the impact later.

6. If you've already completed the previous five steps, there is one additional area for you to focus on: Put extra time and effort into collecting all the funds you can now. It's important for you to bring the days in accounts receivable down now, especially from your top carriers. If not, the days in accounts receivable are predicted to increase beyond your control. This is merely due to the impact that ICD-10 will have on the carriers themselves. Establishing a cushion will help offset the expected cash flow impact. Find space in your employees' workflow to collect both insurance and patient money, especially from the carriers with a higher revenue impact.

Even if you're not quite sure what to do to prepare, or even start, with ICD-10, now is the time to get started. Find the value in trying to work the process every day and you will have more confidence when ICD-10 gets closer.

— Wendy Aiken, PMI-ACP, has been with ADP AdvancedMD since 2011 as a product manager. ADP AdvancedMD offers all-in-one cloud practice management, scheduling, and billing services as well as a pioneer of Big Data reporting and business intelligence. Having worked on the front lines of the medical industry for more than two decades, Aiken is now adding her real-world expertise to the medical software industry. She is the company lead for the ICD-10 Posse, a team wholly dedicated to helping the ADP AdvancedMD independent practice clients succeed, through the ICD-10 implementation process and beyond.