Partner with Health Systems for ICD-10 Readiness

With Oct. 1 approaching and no signs of another delay in sight, the move to ICD-10 is top of mind for provider practices. However, new studies continue to reveal that far too many practices are underprepared for the impending code set change. In August,  the Workgroup for Electronic Data Interchange (WEDI) survey revealed that fewer than half of physician respondents were prepared for the Oct. 1 deadline.

This is, in many ways, to be expected. ICD-10 readiness involves communication between multiple parties -clinicians, providers, health systems -and everyone has to change together, and that’s no small task.

The change will be disruptive. This will be the case in particular for the thousands of independent provider practices around the country that have limited resources and are already feeling the weight of meaningful use Stage 2. Unlike health systems, independent practices will disproportionally feel the burden with limited time and resources available to dedicate to hiring employees and consultants as well as training personnel. These practices must be considering now strategies to minimize revenue losses to continue day-to-day operations as the new mandate takes effect.

For independent physicians, the impact on quality reporting, specificity of documentation, and the revenue cycle will be profound. Under ICD-10, it will be vital for physicians to document a patient's specific symptoms in order to get paid. Without careful documentation, the wrong codes will trigger billing and payment problems that could easily overwhelm small practices and leave them vulnerable to reimbursement penalties. With the code set increasing from nearly 15,000 to approximately 70,000, it is a considerable undertaking and one that many independent practices will not be able to accommodate without significant support and coordination.

Fortunately, physician practices are not in this alone. Health systems are also facing the impact of the code set change, and they stand to benefit significantly if their network of independent community physicians is also prepared for the change. The two disparate entities must work together to ensure codes are entered accurately their first time, so as not to lose time and money from inefficiencies and delays with coding errors and denials. Prudent providers should be engaging in dialogue  with their partnering health systems to create pathways to ICD-10 success.

Technology will play a critical role in ensuring a successful transition for both partners. One solution lies in health systems sharing their cloud-based systems with independent providers. These tools can help guide and present the right codes for selection, supported by the clinical documentation. The systems aid the selection of the correct ICD-9 and ICD-10 codes, both now and after the Oct. 1 conversion. Independent providers and health systems can benefit from these available tools and technologies, ensuring accurate data exchange.

New cost-effective community care business management tools that coordinate referrals and orders for patients, as well as ensure that episodes are coded accurately are also very attractive ICD-10 solutions. They can make the lives of both parties easier by saving time and money that would be lost by scrubbing and changing codes during each transaction. Overall, this can improve efficiencies and provide overall peace of mind around ICD-10 transactions.

Consider the following: A patient comes into the office with a broken arm and when entering the care episode, the physician does not specify which arm. Under the new code set this would not trigger any reimbursement. However, if the physician’s office is using a cloud-based solution from their health system trading partner, the clinician selects the specific diagnosis from the drop-down menu and it auto-populates the reason for the visit, along with appropriate ICD-9 and ICD-10 codes. The clinician would then enter the patient data, which shows everything the provider office knows about the patient, including insurance information, and a correct order is submitted, ensuring the practice is reimbursed for the care episode.

ICD-10 implementation is just around the corner, and providers nationwide are preparing for the transition the best way they know how, with the resources available to them. Physician practices must examine and plan for likely disruptions and consider the agile technologies that exist to assist front-office staff in ordering and referring properly, ensuring the correct codes are used to drive the correct authorization determination, improving efficiencies, and guaranteeing practice revenue predictability. Most importantly, physicians can ensure relationships with their community trading partners -hospitals and health systems -remain strong while giving time back to what really matters, clinical care, and patient health.

Bill Reid is Senior Vice President of Product Management and Partners, SCI Solutions