November 23, 2015

Preparing Small Physician Practices for ICD-10

By Wendy Aiken, PMI-ACP

Over the course of the past three years, practice management vendors have been tasked with understanding all the nuances of ICD-10, updating their applications to meet these requirements and ensuring their clients were as prepared as possible for a successful transition. 

Smaller physician practices faced unique challenges as their employees often play multiple roles in the office and it’s rare for one person to be able to devote a great deal of time to changing processes and training on application changes. Fortunately, we were able to get clients engaged and prepared, resulting in a smooth transition, with their first ICD-10 payment received only seven days after the Oct. 1 deadline.

As part of AdvancedMD’s continuing commitment to help our clients stay one step ahead of compliance changes, three long years ago, we formed a cross-functional team of experts to provide tools and education on the ICD-10 transition for our clients as well as our employees. We built tools based on the needs of small physician practices and were thrilled to see our clients engaging in ICD-10 preparations. Practices took full advantage of our educational tools and “Ask the Expert” webinar series, where they could pose questions about the application and industry trends to assist with their preparations.

The webinars were so successful that we’re continuing the series for the foreseeable future. With these tools at our clients’ disposal, we found that they needed far less assistance during the week of the transition than we had anticipated and our support calls regarding ICD-10 even decreased the first week of October.

With 90 percent of the AdvancedMD client base currently sending ICD-10 codes, the belief is that, at least for now, this trend will stabilize at this level, as some clients will continue sending ICD-9 to Property & Casualty carriers like Workers Comp who are mandated by state law rather than federal regulations. This required Practice Management systems to allow for dual coding and will remain a requirement until all states have adopted ICD-10.

Along with meeting all the compliance changes and ensuring dual coding was in place, we also knew how important it would be for our physicians to quickly and easily find the right code while not impacting the patients’ face time.

To meet this need, AdvancedMD added robust all-in-one diagnosis search and mapping tools to the PM, her, and mobile apps to allow physicians to get to the correct code before leaving the exam room, which will alleviate work for the billers, prevent denials, and ensure charts notes are aligned with the coding. 

While the industry as a whole has seen a smooth transition so far, there are still trends that vendors, payers, and practices should keep an eye on. AdvancedMD has formed an ICD-10 Response team to review client-specific data like exclusions, rejections, and denials, and proactive assistance is provided to clients. For instance, when a client has exceeded a normal rate of rejections, the support team reaches out to make sure the client is aware and offers help or advice. Exclusions and rejections are also being researched to build front-end edits to catch potential issues, and the definitions of the messages coming back are being expanded to provide clarity and assist with early detection of problematic claims.

In all our communications, we have encouraged clients to understand the coding standards, familiarize themselves with the clinical situations expected to have the highest level of specificity, and put processes in place to ensure they are compliant with these standards. The concern is that as carriers start getting into a rhythm of adjudication, over the next six months an over-utilization could potentially result in large spikes in denials across the board, which would be costly to providers. 

We would all love to see continued success with this transition, and we’re hopeful that with open communication among Practice Management vendors through organizations like HATA and through channels like ICD10Monitor, collectively we can start encouraging more specificity to avoid problems and stay on this positive path of keeping our practices financially healthy. 

About the Author

Wendy Aiken is the product manager for AdvancedMD.

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