For the procrastinating physicians, it's time to figure out how ICD-10 coding will affect medical practices.
The American Medical Association (AMA) covers the assessment nicely as part of its free educational resources. I found some tips from the Centers for Medicare and Medicaid Services (CMS) and created a hybrid check list.
Start your assessments with:
List work processes and current electronic systems that use ICD-9 codes. The AMA suggests looking at:
- Claims submission
- Billing system
- Posting payments
- Clinical documentation, e.g., patient reports, electronic medical record
- Patient registration system
- Checking patient’s eligibility
- Verifying referral/prior authorization
- Writing referrals
- Writing orders
- Encounter forms
- Coding tools, e.g., “superbills”, programs, books, resource materials
- Quality reporting
- Public health reporting
- Disease registry/disease management
- Health insurance contracting
- Laboratory systems
- Where else?
Evaluate how ICD-10 will affect your practice
- Identify the diagnoses most frequently used.
- Look up these diagnoses and review the potential new codes for the best match.
Identify staff who work with ICD-9 codes and how their job relates to those codes
- Look for them in the previous list of affected departments.
- Understand how your clinicians and coding/billing personnel communicate.
- What words do they use to describe their routine protocols to medical coders/billers?
Identify possible work flow changes needed to implement ICD-10 codes (e.g., data collection forms, encounter forms, superbills)
- Medical coding
- Training for medical coders
- Increased to time to process medical claims
- Managing the increased queries for physicians and clinicians
- Physicians and clinicians
- Clinical documentation
- Quality improvement
- Case management
- Information Technology
- Internally (home grown) developed applications
- External applications (Review contracts for commercial information system applications)
- Generating reports
- Inputing
- File importing
- Data warehousing
- Decision support
- Research
- Financial management and revenue cycle
- Productivity
- Reimbursement Structures
- Pre-Authorization
- Eligibility
- Scheduling
- Admitting/Registration
- Charges, Coding
- Claims/Billing
- Collections/Follow-up
- Payment Posting
- Denials Management
- Education/Training
- Business practices
- Referrals
- Authorizations/pre-certifications
- Patient intake
- Physician orders
- Patient encounters
- Clinical documentation: The increased specificity will require that patient encounters are documented with greater detail.
- Staff training
- Physician workflow
- Patient volume
- Forms, documents, and encounter forms need to be revised to reflect ICD-10 codes
- Processes for ordering and reporting lab/diagnostic services to health plans
- Evaluate whether clinical documentation can support ICD-10 specificity
- Prepare clinical documentation improvement (CDI) strategies
- Identify how staff will enter key words, medical notes and content in medical records.
- Determine if hiring a consultant is needed as a part of your implementation process
You need to take this time to make sure you're going to make all the necessary changes this year. Better now than Oct. 1.
