PRACTICE TRANSITION TO ICD10
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Transcript PRACTICE TRANSITION TO ICD10
PRACTICE TRANSITION TO ICD10
ADSoyerDO
AAOS Practice Management Committee
AAOS San Francisco February 10, 2012
Disclosures
AAOS Practice Management Committee 2010-12
IMPLEMENTATION OF ICD10
Where to begin?
No US tested model in place for implementation
Draw on experiences from EMR transition
Look at experiences from Canada
Challenges to Implementation
In addition to ICD 10, HIPAA will be updated from
version 4010 to 5010
Overlap between both
Will require preparedness for both conversions
Impact of ICD Implementation
Total Cost Impact Nachimson Advisors, LLC 2008
Small Practice $83,290
Medium Practice $285,195
Large Practice $2.7 million
Total Cost Impact
Costs Arise from 6 Key Areas
1. Staff Education & Training
2. Analysis of Health Plan Contracts, Coverage
Determination & Documentation
3. Changes to Superbills
4. IT System Changes
5. Increased Documentation Costs
6. Cash Flow Disruption
Staff Education & Training
Clinical & Administrative Staff will require significant
time to learn new codes
Learned patterns will have to be re-learned because of
the changed structure and organization of the code set
Business-Process Analysis of Health Plan Contracts
Assessment of ICD 10 impact on business processes,
including provider health plan contracting
Health Plans may modify provider contracts to comply
with greater specificity required by the ICD 10 mandate
- adjusting payments accordingly
Coverage determinations may also be revised in
accordance with new diagnostic codes and additional
documentation required to support patients’ treatment
plans
Changes to Superbills, IT System
Superbills will need to be changed to support 5x
number of codes.
Software changes and associated costs to EMR
IT costs of ensuring compliance of Practice
Management / Billing software and Clearinghouse
Vendors with ICD 10
Increased Documentation Costs & Cash Flow Disruption
Additional documentation will be required to
support the patient’s diagnosis
- less time for clinical work = decrease in
productivity
Health plan payments will be changing based on
severity of diagnosis and changes in coverage
There may be significant changes in reimbursement
patterns disrupting cash flow
Total Cost Summary
Total Cost Summary
Typical
Small Practice Medium Practice
Large Practice
Education
$2,405
$4,745
$46,280
Process Analysis
$6,900
$12,000
$48,000
Changes to Superbills
$2,985
$9,950
$99,500
IT Costs
$7,500
$15,000
$100,000
Inc Documentation Costs
$44,000
$178,500
$1,785,000
Cash Flow Disruption
$19,500
$65,000
$650,000
TOTAL
$83,290
$285,195
$2,728,780
Canadian Implementation Experience
Implemented in 2001, 12 month trials prior &5 yr
transition period completed in 2006
4 phase approach (education/training, IT support,
trials, maintenance/ upgrades)
Lessons to be learned
Dedicated training staff, IT development, Gantt charts
Differences:US & Canada
Canada has Universal Healthcare
Decisions & funding from one source
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok3_0055
58.hcsp?dDocName=bok3_005558
ICD 10 & HIPAA version 5010
Obstacles to Implementation:
1. to busy with EMR / meaningful use
2. scarce technical resources
3. some payers systems aren’t ready
4. some vendors systems aren’t ready
5. some clearinghouse systems aren’t ready
www.cms.gov › Medicare › Electronic Billing & EDI
Transactions
ICD 10 Timeline
Step 1- Impact Analysis (3-6 months)
Step 2-Contact your Vendors (2-3 months)
Step 3- Contact your Payers, Billing Service &
Clearinghouse (2-3 months)
Step 4- Installation of Vendor Upgrades
(3-6 months)
Step 5- Internal Testing (2-3 months)
Step 6- Update Internal Processes (2-3 months)
ICD 10 Timeline
Step 7- Conduct Staff Training (2-3 months)
Step 8- External Testing with Clearinghouses,
Billing Service and Payers (6-9 months)
Step 9- Make the Switch to ICD 10- Oct 1 2013
www.ama-assn.org/go/ICD-10.
Preparation
AMA Guide
Identify your current systems and work processes
in which you use ICD 9 including:
- Clinical documentation
-
Superbills
PMS (Practice Management System)
EHR
Quality reporting
Contracts
Preparation
Talk to your current PMS vendor
Questions to ask:
Can my current system accommodate data format changes
for ICD 10 codes?
Will they be upgrading your system to accommodate
the new codes? If yes, will there be a fee?
When will upgrades be installed?
When will implementation be completed?
Preparation
Talk to your Clearinghouses &/or Billing service
Questions to ask:
Will they be upgrading your system? If so, When?
When can you send test claims (with ICD 10 codes)
to see if they are accepted?
Preparation
Talk to your Payers about possible changes to your
contracts from implementing ICD 10
Questions to ask:
Do they plan on re-negotiating contracts? If yes, when?
At time of renewal or prior?
What impact will ICD 10 have on your payment,
medical review, auditing and coverage?
Preparation
Identify potential changes to existing practice work
flow and business processes
Consider these areas:
Clinical documentation
Superbills
Quality reporting
Preparation
Identify Staff Training needs
Who gets trained & in which areas?
Develop program with training leader who in turn
trains other staff
Resources:
http://www.ahima.org/icd10/role.aspx
Preparation
Budget for Implementation costs
- expenses for system changes
- practice business process changes
- resource materials
- training
- consultants
Recommendations
Use your experience from EMR transition to alter
workflow & anticipate revenue shortfalls
Access to credit line for implementation costs and
cash shortfalls post Oct 2013
Utilize your EMR vendor & Clearinghouse tech
support- If any doubt in their ability to make
seamless transition, NOW is the time to switch.
AAOS resources ( e.g Gateway program)
Consultant?
Thank You
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