practice transition to icd10
DESCRIPTION
ADSoyerDO AAOS Practice Management Committee AAOS San Francisco February 10, 2012. PRACTICE TRANSITION TO ICD10. Disclosures. AAOS Practice Management Committee 2010-12. IMPLEMENTATION OF ICD10. Where to begin? No US tested model in place for implementation - PowerPoint PPT PresentationTRANSCRIPT
PRACTICE TRANSITION TO ICD10
ADSoyerDO AAOS Practice Management CommitteeAAOS 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 $46,280Process Analysis $6,900 $12,000 $48,000
Changes to Superbills $2,985 $9,950 $99,500IT Costs $7,500 $15,000 $100,000
Inc Documentation Costs $44,000 $178,500
$1,785,000Cash 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_005558.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?
