This article was originally published on HIT Consultant. Are you ready for the ICD-10 transition? That’s the question most healthcare providers loathe, as the October 1st deadline nears and the potential for major problems and productivity loss grows. No one knows how many hiccups and headaches the more than 64,000 codes will create—but having the right EHR products in place can help you prepare—according to eMDs’ Mike Liter. As Vice President of Account Management & Implementation at eMDs, a leading provider in ambulatory electronic health record (EHR) and physician practice management solutions, Liter provides insight as to how the right EMR/EHR solution can mitigate the inevitable growing pains providers will face with ICD-10 transition:
Naturally, there are a lot of concerns coming our way with ICD-10 conversion. It’s inevitable that it will slow down operational and care methods, affecting patient satisfaction and care quality. What do you see as the largest issues looming, especially in the areas of ambulatory services for providers?
The transition to ICD-10 is the biggest change to face our industry in decades. Essentially, everything associated with coding a patient encounter and submitting it for payment is going to have to change. And to your point about slowing down the ambulatory practice, productivity is likely to decrease across the board as physicians take more time to document the encounter and interventions, and coders travel up what is to be a very steep learning curve. There is the very real chance that a lot of software out there is simply going to break. Some staff may opt out of the whole transition, spurring an uptick in turnover. Everyone is expecting a significant spike in denials, as increased levels of specificity leads to more complexity in adjudicating a claim. So, how do you survive the transition? Definitely start by not underestimating the degree of change required. And don’t skimp on training—train, train, train and then train some more. Docs will not be able to learn this on the fly. Coders will need to be re-certified. AR and billing people will need to understand the new coding schema to manage the follow up processes. Attempting to wing this alone isn’t realistic. The best option for many practices will be to engage with a technology partner that has already invested in the tools, systems and training, and can provide a turnkey solution for transitioning to ICD-10.
Keeping those very real problems in mind, your company’s perspective is that a health organization’s EHR can play a huge role in helping providers weather the storm that’s coming with the ICD-10 transition. How so? What makes this a realistic statement instead of a clever pitch for an EHR product developer?
Your EHR is probably the most important tool you have in the ICD-9 to ICD-10 transition. Since mapping from ICD-9 to ICD-10 will in most cases not be one-to-one, EHRs help guide providers to the appropriate ICD-10 diagnosis. There are a number of functions and features within the EHR to assure that users are selecting the most specific, billable, ICD-10 code for a particular diagnosis category. Some examples include:
- Templates that guide clinicians to the correct, specific ICD-10 codes
- Print and export functions to support medical necessity
- Coding crosswalks and dual coding tools to help choose the correct ICD-10 code
- An electronic superbill that’s more usable than a paper superbill
- Search tools to look up codes by diagnosis keyword, ICD-9, or ICD-10 codes to easily surface ICD-10 results
- Automated mapping to view ICD-9 and ICD-10 codes side-by-side
So if the quality of a provider’s EHR product really plays a central role in mitigating some of those ICD-10 pains and strains, what should a provider look for to make sure that he/she has the best EHR for the tall task ahead?
Well, certainly verify the solution has the above capabilities. Along with that, there are a number of other questions it will be important to ask. The following are the most pertinent to identify an EHR that’s fully ready for ICD-10 and also supported by training and testing from a knowledgeable vendor. When will your ICD-10 compliant system be ready? At this late date, if your EHR vendor cannot answer this question, you will not be ICD-10 ready. Hopefully, your vendor has been communicating its ICD-10 transition plan to you all along and has been guiding you through the phases to a successful transition. Are there any additional costs involved for upgrades or ongoing maintenance? Some EHR vendors are issuing software upgrades, while others are producing an entirely new version of their products. Ask if you will be charged for the software updates, and how much. My feeling is that a true partner should consider it their job to make sure the system is compliant, and not charge clients any extra fees to complete this work. What customer support and training will be provided? If your EHR partner is planning software updates, this means your staff will need training on new templates, layouts and processes. So that should be the minimum expectation for training on the product side. Additionally, ICD-10 will bring with it a whole new blitzkrieg of changes to workflow. Look for a vendor that will work with your practice to appropriately prepare your staff for the change. Online training EHR programs, for example, allow staff to train on changes when and where they choose. Self-assessments are another useful training tool, and indicate where staff excel and where more attention is needed. What is the basis of your crosswalk or mapping strategy? GEMs will be a useful crosswalk tool, but it won’t be enough. Only one quarter of the ICD-9 codes will have an exact match in ICD-10. The reality is that GEMs helps to ease the transition to ICD-10, but it is not the long term solution. In fact, there’s no one silver bullet. Training and education is a huge component of the ICD-10 migration. That said, a savvy EHR vendor will supplement GEMs with extended search capabilities. Natural language parsing allows users to use simple clinical keywords to find the appropriate code. “With,” “Without,” and “And” promote improved specificity. SNOMED-CT can be mapped to ICD-9 and ICD-10. “My lists” and “Frequently Used” lists will need to be enhanced to include the ICD-10 code sets. Be sure to ask if the system supports non-covered entities that don’t have to make the transition to ICD-10 immediately. Automatic code set selection, based on known payor readiness, is helpful here. Will your product support dual coding? This is an important training tool. Dual coding allows medical coders to simultaneously use ICD-9 and ICD-10 codes in a chart to practice using the new system. Finally, dual coding also allows for testing with outside organizations, like payers and clearinghouses, to be sure that all systems are a go before they’re actually needed. What is your external testing strategy? External testing is a critical part of the ICD-10 conversion process, and a key factor in assuring that revenue will continue to flow after the transition. Find out when and how your partner plans to test their products. Catching problems before they start affecting your bottom line will save you many headaches come transition time.
What about employee training? How fundamental is it to have a premeditative training plan in place, and what should that training method or process look like? How can one make sure that the EHR product is up to snuff when it comes to assisting in that training?
eMDs has been contacting every single customer and conducting a readiness assessment as part of our plan to help them with the transition. This also helps our clients understand the requirements. We also have a comprehensive ICD-10 resource center for our customers they can refer to on demand. Tips, tricks, recorded training, and guidance documents on how to ease the transition, how to test, and other ICD-10 topics are always available at the online eMDs Resource Center.
There are some providers who feel they are arriving late in the game to tackle the transition. For them, this is more than a monumental task. What do you say to those who are just starting to think about tackling the ICD-10 transition? Is it too late for them to mitigate the productivity loss that’s coming?
It’s not too late, but the clock is ticking. An impact assessment is the single most important task in your ICD-10 transition. Understanding all the areas and people that will be impacted will help you understand the work at hand and how to budget time and resources appropriately. You will be more likely to cover all your bases if you start out in a very organized way and break it up step-by-step. Your impact assessment should evaluate how ICD-10 will affect:
- Business practices
- Documentation changes
- Systems and vendor contracts
ICD-10 will affect nearly all areas of your practice, but with a thorough impact assessment, you can keep your day-to-day activities running smoothly while you make the transition.
We have learned a few things from other countries’ ICD-10 transition, including Canada’s. What we learned from their approach is to not only understand the importance of coder training, but also really understand where your organization stands in terms of operational productivity, billing, and even clinical documentation practices. Are these all areas where a good EHR can provide robust assistance? Because as we move toward a shift of value-based care, the consensus is that an EHR cannot do it all. What do you say to those claims?
It’s true, an EHR alone won’t cut it. You need a vendor that provides a full suite of services addressing your clinical, financial and administrative needs. This means an integrated system that offers EHR, PM and RCM services. Circling back to the expected rise in denials as claims get more complex to adjudicate, while your EHR can be enormously helpful in making sure codes are correct, there a number of RCM tools that can assist in navigating the myriad of additional Local and National Coverage Determinations increasing the likelihood of a clean claim. These included automated claims editing, which scans and flags for errors before submitting a claim; automated patient eligibility verification; authorization verification, to name a few. A vendor that can provide all of these services can also integrate them seamlessly into the EHR.
What should providers anticipate in the few months post ICD-10 and how can they mitigate these risks?
In the first few months post ICD-10, patients are likely to see:
- Intake delays from the new documentation required for ICD-10
- Denials of benefits due to inaccurate coding
- Erroneous coding due to data entry mistakes
- Registration or scheduling delays
To mitigate these risks, processes and procedures related to patient registration, intake, and discharge must be thoroughly reviewed and upgraded. In addition, front-office staff will need basic training in ICD-10-CM and ICD-10-PCS. Longer term, ICD-10 is critical in order to move forward with value-based models, not to mention the anticipated benefits from more accurate payments, improved disease management, surveillance of pandemic threats, and the ability to reduce complications of care by more accurately identifying the factors and circumstances surrounding a patient and to accommodate new treatments and technologies such as minimally invasive surgery that have made ICD- 9 obsolete. Ultimately, the patient benefits from these changes.
How important will automated patient outreach and engagement features be when we talk about the transition to value-based care? Again, won’t providers have to add more sophisticated software to serve their population health management (PHM) goals, overshadowing the functionality of their existing EHRs and diminishing the importance of such products?
We are entering an unprecedented collaborative era in healthcare, from ACO care delivery models to Big Health Data projects with numerous stakeholders. Today, healthcare organizations of all sizes must be able to exchange electronic data. Look for an EHR with proven and successful interfaces with major e-prescribing companies, diagnostic labs, HIEs and other healthcare entities.
We’ve covered a wide array of what’s to be expected with the ICD-10 transition. What’s the one consideration providers are overlooking that you think needs more attention?
Again, training. Mastering the complexity and granularity of ICD-10 will require a tremendous amount of preparation and practice. And yes, physicians will require extensive training too. Even if they don’t input the final coding of the encounter, they will need to understand the new documentation requirements. Some considerations of the training plan:
- Physicians and coders will require the most time
- Local or distance options are available (boot camps, conferences, online training, webinars)
- You will likely need to add resources during the training process – temporary help or overtime
- Make sure training materials are available to your staff
Starting now will help bridge the gap in the shortened window prior to transition.
Lastly, what’s the key takeaway here, as we approach the deadline for ICD-10 transition? If there is one thing to keep in mind as the deadline nears, what is it?
As hard as it is, try to plan for the unforeseen issues and those issues you have no control over. Even with adequate training this is a completely new dynamic. Systems are new, processes are new, etc. Productivity is likely to decline which will result in reduces claims going out and subsequently less consistent cash flow. As well, payors are transitioning to the new code set parallel to the providers and there is no way to foresee processing delays that could slow cash flow. Practices should work to stabilize as much days cash on hand to assist during the transition and potential payment delays.