May 14, 2013

Advice for Physician Practices: MGMA Advisor Offers Tips to Keep Your Doors Open

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“We don’t want to say this, but you may have to identify a contingency plan,” said Robert Tennant, senior policy advisor for the Medical Group Management Association (MGMA), on ICD-10-Monitor’s Talk Ten Tuesday broadcast last week. He told physician practices exactly the way it is, saying:

“Practices experienced rejected claims and weeks of diminished cash flow when they transitioned to 5010. ICD-10 promises to be even more difficult…,” he said. MGMA’s advice: “Establish a line of credit, avoid large expenditures, put aside cash reserves, and identify potential workarounds in case vendors aren’t ready so you can ensure your doors stay open.”

 

However, better yet, “start early and be proactive,” and continue to move forward as the ICD-10 timeline diminishes. Tennant presented the following low-cost, low-impact steps that physician practices can take now to minimize the changes and cash disruptions ahead.

  • Develop an internal implementation team with a leader. Set goals, objectives, and timelines; create a budget for the organization; and assign various tasks to be completed.
  • Identify practice areas that will be impacted by the coding system change as well as any software that uses diagnosis codes. The most obvious are practice management and electronic health record (EHR) systems, but also remember other less obvious systems: accounting, case management, quality-assurance management, and test-ordering, for example.
  • Understand the cost for software upgrades and necessary hardware changes.
  • Conduct an internal review of the practice’s current clinical documentation, and determine whether physicians are capturing sufficient detail to assign appropriate ICD-10 codes. As Tennant says, “I can’t emphasize enough the importance of this step.” If the review cannot be conducted by internal office staff, outsource it to a consultant or vendor.
  • Communicate with vendors and ask “tough questions” like the following, he says: When will you be ready to accept I-10 claims? When can I test my system? When will you update your software? When contacting practice management and EHR software vendors, ask these: Will you offer ICD-10 training for staff? Will you allow us to perform dual coding, and, if so, when and for how long? When can I test internally? And when can I send test claims to my clearinghouse and health plans?
  • Determine which health plans comprise the bulk of your business and contact them first. When will they accept test claims? Will you send through third party OR direct to health plan?
  • Identify staff training needs. For example, provide information that gives administrative staff an overall understanding and assign coders to hard-core I-10 boot-camp training, and ensure that it is just-in-time training—not too soon and not too late. As Tennon warns, “If you train staff too soon they will need to be retrained before the compliance date, but don’t leave it until too late because you might have to scramble to find program slots and training will be rushed.”

 

Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for RACMonitor.com and ICD10Monitor.com; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.