6 Questions to Assess Your Practice’s ICD-10 Readiness

Lea Chatham March 24th, 2014

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By Lisa A. Eramo

Kareo ICD-10 resourcesIf there’s anything that most of us learned in school, it’s that procrastination is never a good thing. It can cause unnecessary stress and result in a potentially disastrous outcome (failed final exam, anyone?).

Physicians: Apply this lesson to ICD-10. Do you know whether your practice is ready?

Waiting until the last minute to prepare for this monumental change can delay cash flow and impede even the most efficient practice. Why not plan in advance and save yourself the headache?

Unfortunately, many physician practices aren’t getting the message. Only 4.7% of practices have made significant progress toward ICD-10 readiness, according to a June 2013 survey published by the Medical Group Management Association. Fifty-five percent haven’t begun implementation at all.

Jacqueline J. Stack, BSHA, CPC, CPB, CPC-I, CEMC, CFPC, CIMC, CPEDC, AAPC director of ICD-10 training and education, says practices—particularly smaller practices and solo practitioners—need to assess their readiness for ICD-10 so they can get the ball rolling. It’s time to face the music and ask those difficult questions to see just how ready you are, she says.

Question #1: Have you accepted ICD-10, or are you still in denial? Hoping for another delay is not the answer. Use this precious time to begin preparations rather than bury your head in the sand of denial. If your staff members see that you’re embracing this change, then they will too.

Question #2: Is someone in charge of the effort? Putting someone in charge of ICD-10 allows you to focus on patients while ensuring staff readiness. Tweet This
In most practices, either the practice manager or a lead coder will assume the responsibility of ICD-10 coordinator. Once identified, ask your ICD-10 coordinator to create a formal task list and identify those who need training. Does your ICD-10 coordinator know where to find ICD-10-CM resources?

Question #3: What does your documentation actually reveal? Ask your ICD-10 coordinator to run a frequency report of your top 50 most frequently reported diagnoses. Your coordinator should review documentation for these diagnoses to ensure that it can support the assignment of ICD-10 codes. If the documentation results in assignment of an unspecified code, ask your ICD-10 coordinator to explain why. Does the diagnosis require laterality? Anatomical specificity? Your coordinator should be able to provide you with a cheat sheet or other tool to aid in your documentation. Ensure that this individual has the time and resources to compile and develop this information.

It may also be helpful to undergo an ICD-10 clinical documentation assessment using an outside company or consultant, such as the American Academy of Professional Coders (AAPC). The best way to prepare for ICD-10 is to ensure quality documentation through multiple audits and corrective action.

Question #4: Are your staff members are ready? Ask your staff members how comfortable they are with ICD-10. Don’t assume that they can learn easily or that they are learning it on their own. Establish a formal assessment and training process. Your ICD-10 coordinator should be able to assist with this.

Question #5: Have you contacted your vendors and payers? If your answer is no, strive to change this quickly. Ensure that your ICD-10 coordinator adds these tasks to his or her to-do list:

  • Compile a list of each payer and vendor along with its contact information.
  • Ask each payer and vendor when (i.e., a specific date) it will be able to display or process ICD-10 codes. Track each vendor’s and payer’s progress toward this goal by periodically contacting them.
  • Ask each payer (including Medicare and Medicaid) as well as any vendors when they will be ready for ICD-10 testing. End-to-end testing is important. This means that your ICD-10 coordinator should send claims through your practice management software to each payer. Ensure that each payer is able to receive those claims and send responses back.
  • Contact worker’s compensation and auto insurance companies. These entities are not mandated by HIPAA to adopt ICD-10. Inquire whether they will transition to the new coding system or not. Note that some states mandate that worker’s compensation move to ICD-10.

Question #6: Do you know how ICD-10 may affect productivity? The only way to know for sure is to allow your coders to code a few records each week using ICD-10. How long does it take them to complete each record? Does a delay translate to a potential disruption in cash flow? Will you need to hire temporary staff to answer phones and book appointments so that your staff can concentrate on coding accuracy for a period of time after implementation?

About the Author

Lisa A. Eramo

Lisa A. Eramo is a freelance writer/editor specializing in health information management, medical coding, and healthcare regulatory topics. She began her healthcare career as a referral specialist for a well-known cancer center. Lisa went on to work for several years at a healthcare publishing company. She regularly contributes to healthcare publications, websites, and blogs, including the AHIMA Journal and AHIMA Advantage. Her focus areas are medical coding, and ICD-10 in particular, clinical documentation improvement, and healthcare quality/efficiency.

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