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.

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!