Help Your Physicians Make the Leap to ICD-10

As discussed in my May 2012 blog, only diagnosis codes will change for physician practices and medical groups under ICD-10, not procedure codes. And while physician payment is not driven by diagnoses codes, they are still required to show medical necessity. This is where practices must be thoroughly prepared to make the leap.

It’s important for physicians to understand ICD-10’s impact and how it can ultimately benefit quality of care and their practice.

Explain the Benefits of Greater Specificity

ICD-10 incorporates greater specificity, clinical data, and information relevant to ambulatory and managed care encounters. In addition, the structure of ICD-10 allows for the expansion of code numbers. ICD-10 also extends beyond simply the classification of disease and injuries. It includes the ability to code risk factors that are frequently encountered in a primary care setting.

ICD-10’s magnified degree of specificity provides more detailed information encouraging and supporting providers, payers, and policy makers to:

• Establish appropriate reimbursement rates.
• Improve the delivery of healthcare.
• Improve and evaluate the overall quality of patient care.
• Effectively monitor both service and resource utilization.

Invest in Physician Champions

It will be difficult for physicians to embrace ICD-10. Change is difficult and the transition may be costly. Therefore, HIM professionals and group administrators must focus on helping physicians understand the dynamics involved with the new code sets, and the greater level of specificity required.

To do this, organizations are advised to first identify and invest in the development of a few select physicians. These physician “champions” should understand the ICD-10 processes and support the transition. Let their knowledge of ICD-10 model change for other colleagues who may resist migrating from ICD-9 to ICD-10.

With a little education, encouragement and support all your physicians can successfully make the leap!

AMA Pushes Back Again…The Real Issue

The American Medical Association, not satisfied with HHS’s push-back of the ICD-10 deadline to October 1, 2014, has protested again. Perhaps one of the reasons for their continued dissent is lack of guidance and support.

While much has been published about the implementation of ICD-10 for hospitals, the body of knowledge for physician practices and medical groups is sorely lacking. Vendor upon vendor is assisting hospitals, but who is helping the docs?

I readily admit the move from ICD-9 to ICD-10 is a huge undertaking. However, only diagnosis codes change for practices and groups, not procedure codes. And while physician payment is not driven by diagnoses codes, they are still required to show medical necessity. This is where practices must be thoroughly prepared to make the leap.

Specialty Matters

Family practice, hospitalists and internal medicine groups may have a more difficult time converting from ICD-9 to ICD-10. Specialists will find the transition much easier. Why?

Generalists see a large variety of patient conditions. So their documentation and support staff must be educated in all anatomy, physiology and disease processes—while specialists treat a limited sub-set of the patient population. Therefore their documentation needs to be refined in only a few key areas. And staff only needs to focus on one or two body systems.

To get started, CMS has prepared ICD-10CM information on their website. Now is a good time for practices to test the water with what to expect; and begin developing a training plan, even for single practitioner practices

Tips from TrustHCS

Our experts have also provided some tips for practices and groups to ease the transition to ICD-10. We’re always available to help and support your efforts. We’ll make the move to ICD-10 easier…really!

• Practices owned, managed or affiliated with a hospital should reach out for guidance and resources.
• A targeted, specific training approach is the most cost effective and practical strategy for specialty practices.
• Train in small increments and preferably have another physician involved for peer-to-peer support.
• Deepen your staffs’ biomedical knowledge, particularly in the body systems that you treat.
• Take a tailored step-by-step approach and do a thorough ICD-10 assessment and planning early.
• A period of parallel testing with both I-10 and I-9 codes is recommended if at all possible.
• Work with like practices, payers and hospitals as a regional consortium on the I-10 issues facing you all.

TrustHCS Forms Three-Year Partnership with Allegiance Health for ICD-10 Training, Coder Back-Up and Clinical Documentation Analysis

Coding Consulting Firm also Protects Hospital’s Revenue Stream with DNFB Assurance Program

Springfield, MO, September 28, 2011:  TrustHCS℠, a HIM, compliance and revenue cycle consultancy firm for hospitals, clinics and physician practices, today announces a three-year contract with Allegiance Health of Jackson, Michigan, for their complete ICD-10 Educational Services and DNFB Assurance Program. The announcement was made by Torrey Barnhouse, Chief Executive Officer for TrustHCS. TrustHCS will serve as Allegiance Health’s core ICD-10 training and coding services partner by providing:

• Coder assessments and training
• Ancillary staff training
• Back-up coding support and outsourcing services
• Clinical documentation assessments and physician training

“Allegiance Health took the right approach to ICD-10 education by creating a multi-year plan and getting started now,” mentions Barnhouse. “Based on assessment results and already identified areas of need, TrustHCS will begin training for our 22 coders in late 2011, continuing through the end of 2013, “explains Terrie Vilminot, RHIA, Director, Health Information Management, Allegiance Health.

“It is such a relief to know our training needs will be taken care of by experts allowing us to focus on the many other components of ICD-10 implementation,” mentions Vilminot. In addition, Vilminot’s coders get a jump-start on their education with advanced anatomy and physiology courses, also through TrustHCS.

“We’re employing a very prescriptive approach whereby TrustHCS will establish our training schedule, project manage the entire educational component, and customize our program,” adds Vilminot. “When trying to design what we needed to do for ICD-10 training, it wasn’t until we met with TrustHCS that our team realized this is exactly what we are looking for.”

Smashed Beaks: The High Cost of Doctors Flying Blind

Whether you are a V.P. of clinic services for a large, multi-specialty group or manage a standalone practice, growing your business and making strategic decisions for your future can no longer be made without solid, reliable data. And data can’t be years-old or half-baked. It must be current, complete and comparative.

Most practices simply don’t have the data they need to make good business decisions. Whether it involves staffing changes, workflow re-engineering or which hospital to partner with, doctors are usually flying blind. Day in and day out, we meet with practices and they struggle to answer even the simplest questions:

-          What are your top 10 denials?

-          What are each physician’s productivity statistics?

-          What are the benchmark parameters? Are the defined by specialty, region, or national level?

-          What is the office E/M variances, monthly surgeries performed?

-          Collection rates? Days in A/R?

Having the ability to compare yourself to a peer group, on a real time basis, delivers revolutionary insights for better decision making. Furthermore, as hospitals ramp up to partner and purchase practices, comparative information is mission critical. The Advisory  Board recently presented a primer for MGMA members on what to expect and how to plan for accountable care organizations (ACOs), the next wave of hospital-physician partnership methodologies.

Luckily for everyone, comparative analytics technology is delivering real time feedback from the most comprehensive and widely used source—your ASI 835 file. These tools compare physician performance between peer groups at the local, regional or national level. Armed with real business intelligence, no one will have to fly bind.  Here’s to fewer smashed beaks in healthcare!

Incompatibility Reaction: 7 Tips for Highly Effective Audits

Nobody likes to have their work subject to oversight, grading, and criticism. But most people do like to get educated, improve their skills and make themselves more valuable to their organization. When positioned as a learning experience, coding audits can be extremely beneficial for everyone involved, including physicians.

Whether your audits are internally-conducted or led by an outside, industry consultant, “how” you present findings is critical. Presenting audit results as an educational benefit tends to yield the best results. Here are seven steps for highly effective and collaborative audits.

1. Communicate early in the process with both coders and physicians. Everyone should be aware of the internal and external “eyes” upon them.
2. Remind everyone involved that no one is perfect and even the best coders / physicians can do their jobs better.
3. Work at the individual level when presenting case or employee-specific findings and recommendations. This is where one to one communication is best.
4. Include findings and new learning objectives as a performance goal in employee evaluations.
5. Garner executive level support for your coding compliance program, particularly as it relates to improving physician documentation. Getting the Chief Medical Officer on board is crucial!
6. Be professional, non-threatening and take the time to listen. Present the facts – not opinions. And remember that listening is the most important part of effective communication.
7. Finally, establish an appeal process should coders or physicians disagree with auditor findings. Allow room for discussion and negotiation.

Yes, physicians, coders and auditors can be compatible…even when they sometimes disagree! Share your top tips for audit success here and thank you for reading.

Audit, Assessment or Both? Evaluating Revenue Cycles in Practice

Sometimes physician practices need a focused audit. Occasionally a complete process assessment and re-engineering plan fits the bill. And on other days, the practice isn’t exactly sure what corrective action to take. They simply know the revenue cycle is broken and something must change.

Recently I worked with a busy pain clinic in Southern California. We started with a simple practice assessment, but ended up completely re-engineering the revenue cycle. Here are the highlights!

Symptom: A large, unexplained rise in accounts receivables.

Underlying Cause:

Corrective Measures:

At the end of the month, everyone understood the value of correct coding and its impact to the practice’s revenue cycle. They began working as a cohesive team as the focus shifted from reactive to proactive accounts receivable (AR) management. Finally, they aligned job responsibilities with each individual’s strengths and by doing so, achieved optimal performance from each and every employee.

In the final analysis, everyone had positive intent. And so does everyone in your practice! An external set of eyes and ears made all the difference and quickly led to a stronger, more cohesive organization. Perhaps it’s time for every practice to consider the same.