We are almost there! The CMS cancellations, the political meddling, the dire predictions, the fear tactics; there is nothing that can stop the ICD-10 implementation from “going live” on October 1st. However, it’s not yet time for practice administrators to take that extended vacation they have been holding off on. Rather, it’s time to carefully assess your data and ensure your benchmarks are in place to monitor potential performance and quality issues going into the transition. Moreover, administrators need to review their risk monitoring checklist to ensure even cash flow for the practice. The following article provides tips and strategy that operationalize ICD-10 after 10-1-15.

The first step is knowing your risk factors and check-points. This review should be done by department and included internal and external considerations. A ranking of risks, mitigation strategies, and tools and responsibility for monitoring must be included. For example, a potential risk is having your freshly trained and ICD-10 Certified coder offered a nice raise by the neighboring clinic. First plan of action is to meet with your coding staff one-on-one, addressed their training, process and workload concerns so that you can have confidence that they can be happy and productive in their roles. For example, there may be a particular physician who is resistant to documentation feedback and creates undue stress on the coders ability to meet their daily quotas. Administrators have the ability to alleviate concerns with physicians. Second, verify you have entry or mid-level coding staff that understand the coding process and systems and can code basic office visits if the need arises. These are staff that can be trained in to handle basic claims so your most experienced coders can focus on complex claims in the event of a staff reduction. Lastly, have a hiring strategy ready for immediate roll out that includes a job description, interview process, office space and training plan. Having to hire and train new staff person is a highly probable event. Being 100% ready to embrace the full HR process can equate to success.

Another risk with high probability is Electronic Medical Records or Practice Management System functionality issues. While we have all been assured of readiness you really don’t know the issues you will encounter until you shift the daily workflow volume into ICD-10 coding. Administrators need to have key staff who are aware of the software settings that allow the practice management system to perform. For example, identify how the ICD-10 go-live date is set and understand how to adjust specific payer go-live dates. Expect that some work comp payers will not accept your ICD-10 coded claims initially; verify your system can easily change how a claim is coded and how the system can be setup so future dates of service are coded correctly for the insurance. Secondly, have code search tools tested and trained for providers and coders to allow the highest level of specificity in all ICD-10 coding. You want to avoid staff using a one-to-one cross walk strategy that results in volumes of denied claims and payer requests for medical records. Lastly, you need have a reliable and skilled EMR/PM vendor representative that understands your practice and system setup that can help you resolve issues effectively. Practices must avoid relying on calling the vendor 800 number and hoping for the best. Lastly, understand all the systems that are impacted by coding changes and have daily metrics in place to monitor them. Reports that contain the following data need to be reviewed daily to catch issues early:

  • Claims coded per hour per staff person, under-coded claims and accuracy percentage
  • Claim real-time rejection rates by payer, by physician, diagnosis and procedure
  • Claim Denial and Appeal rates and clinical issue resolution volume
  • Statements, patient calls and collections rates
  • Payer specific cash flow, DSO and aging
  • Review outputs for other clinical KPIs and practice compliance reporting, including: disease management, research, contract management, treatment coverage decisions, etc.

Having specific staff people assigned to monitor and report on these reporting areas is critical to success. Setup a 15 minute daily check-in or “huddle” to get the information from your staff and identify issues and solutions early. All too often a big issue is identified and staff tell you they knew something was not right but didn’t know how to dig into it or bother to mention it. This type of delayed response is unacceptable and having a daily forum planned in advance is recommended. Getting the forum is the first step, knowing how to ask the right questions will avoid back-logs and inaction.

Practices should go into October 1st with all back-logs cleared as much as possible:

  • Have all provider documentation completed and approved to send claims
  • Ensure your coding is within a 48 hour turn-around from date of service
  • Review claim authorization requirements for ICD-10 and update any authorizations necessary
  • Maintain combined insurance and patient aging below 10% over 90 days

Having the ability to quickly shift staff resources in the event that large volumes of claims need to be revised or a surprise “project” comes into play is a great way to mitigate risk. If staff are already bogged down by their regular workflow this may not be possible. Identify backlogs, define what it will take to work them down and assign overtime if necessary.

While training should be completed in advance of October 1st as much as possible, there will be additional training needed. Having a ready training resource to deploy, as well as training strategies, budgets and time allocation are key to quickly addressing training needs. Another element of training is a having a bi-weekly staff check-in with clinical and billing staff talking through concerns together. Make sure that best practices are shared and not ad-hoc solutions to issues. Assign a staff person to document and provide follow-up after discussions to clarify what is agreed upon by the group. Ensure that staff understand the escalation process so they can raise issues in a way that gets them resolved effectively. Have your daily metrics reports available to staff so they can review and provide input on causes.

Outsource Receivables works with their practices to implement training and processes around each of these areas. ORI also uses a specialty focus for staffing to allow revenue cycle management staff to go deep in a given area and see data across a variety of practices and claim types. Staff collaborate across specialty areas in daily 15 minute “huddles” which provides a forum for sharing, problem solving and client feedback. ORI’s documentation audits, training and coding feedback help providers and practices correct issues early on and keep cash flow consistent. With all of the challenges of industry changes, technology upgrades and workflow complexity, collaboration is no longer optional. Contact Outsource Receivables to understand how a partnership approach can work for your practice.

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