Surviving the ICD-10 Delay – HITECH Answers : HITECH Answers






Five Unknowns to Consider

By Rex A. Stanley, RN, CPC, CMM, PCS, CHBC, CRS, CPCO, President of Alpha II, LLC
Twitter: @Alpha_II

How the ICD-10 delay was wrapped into the SGR bill, approved by Congress, and signed into law with such lightning speed may remain a mystery forever. Depending on how prepared you are to transition from ICD-9 coding to ICD-10, however, physicians and hospitals can demystify some of the unknowns caused by the delay to govern their organizations effectively. In my opinion, the top unknowns are as follows:

  1. What is the real deadline? The deadline to implement ICD-10 has been delayed from October 1 this year until October 2015 at the earliest. If your organization is on schedule for the switchover, or you haven’t begun to prepare for the new coding, knowing the real deadline will significantly influence how you manage the delay and your bottom line. If you’re on track for ICD-10, do you retain your training team and stay the course, only on a slower and steadier pace? Or do you dismantle it and try to rebuild it later? Either way, the decision affects human resources and expenses. Further complicating matters, there are still discussions of bypassing ICD-10 and jumping directly to ICD-11 by 2018.
  2. Will CMS release ICD-9 updates? ICD-9 and ICD-10 codes were frozen to accommodate the transition, but now that implementation is stalled, will CMS update ICD-9 codes soon to meet the pressing need for new procedure codes? Hospitals particularly will need to watch this closely to update systems faster than usual to have codes ready by October.
  3. Will modifications to ICD-10 codes be issued? The ICD-10 Coordination and Maintenance Committee did not plan to release the 500-plus modifications to ICD-10 until a year after implementation. Now that the timeline is extended, will they release them now? If so, and if you’ve already begun ICD-10 training, you’ll have to adjust your education and the code sets in your software. And, since we don’t know when these might come out, you’ll need to be prepared to move quickly to accommodate these significant changes.
  4. How will LCD (Local Coverage Determination) policies affect coding, claims and billing? Preliminary policies, reflecting ICD-10 coding, appear to be woefully inadequate, mapping ICD-10 codes to GEMs (General Equivalence Mappings) and resulting in at least one ICD-9 code that maps to 1, 467 ICD-10 codes. Does that sound right to you? Physicians and hospitals using automated coding, claims and billing solutions may fare better than others. By being able to edit their own claims and mine proprietary databases they can continue to demonstrate medical necessity and ensure appropriate payment, regardless of ineffectual policies.
  5. Will training support be available? If you started training and suspend it temporarily and hope to resume it later, or if you expected to train at the last minute, there may not be resources available. When the last ICD-10 deadline was pushed back from October 1, 2013 to this year, many training companies saw their business plummet, but decided to remain in business despite losing money. With the latest delay, will they be able to hang on further or will they be defunct by the time you need them? If you haven’t started training, I suggest engaging training resources now to ensure support when you need it. Again, providers using robust coding, compliance, claims editing and revenue analysis software are in the strongest position to weather this period of indecision because extensive clinical and administrative training may not be necessary.

The first three unknowns above rely on the government, so all you can do is be aware of them and monitor them closely to see how they roll out. But physician and hospital leaders can take control now by leveraging IT resources that put you in the driver’s seat for ensuring payment, protecting you from ineffectual policies, and lessening your reliance on training resources that may not be there to help at the crucial time.

About the author: Rex Stanley is president of Tallahassee, Fla.-based Alpha II, LLC, a company that develops data content and rules engines that drive ICD-9 and ICD-10. With more than 35 years of experience in healthcare, the former CEO of Unicor Medical, Inc. in Montgomery, Ala., has extensive knowledge of coding, reimbursement, compliance, and fraud and abuse issues. He has held a variety of clinical and administrative leadership positions, including chief financial officer for a 68-physician multi-specialty group. A member and former leader of numerous professional and honorary associations, Mr. Stanley is an esteemed consultant and a nationally known speaker at conferences across the United States.




Tags: Alpha II, ICD-10, Rex Stanley

Category: EHR Adoption, Health Information Exchange (HIE)


Athenahealth, Inc (NASDAQ:ATHN): Opportunities In ICD-10 …









Posted by: : Viraj ShahPosted on: March 31, 2014

Athenahealth, Inc (NASDAQ:ATHN): Opportunities In ICD-10 Transition Program



The implementation of ICD – 10 transition program is providing lucrative business opportunities for companies like athenahealth, Inc (NASDAQ:ATHN). The world is transiting from ICD-9 to ICD-10 and even U.S. healthcare sector is grappling with the issues regarding this transition.

ATHN is a gamble according to Shayne Heffernan Economist at HEFFX, the numbers here are ugly but if they capture the market they are after there is a lot of upside, only buy this if you are confident in the management”

ICD-10 and the opportunities:

ICD-10 refers to the tenth edition of the International Classification of Diseases (ICD). It is a standard diagnostic tool and is used for health management, epidemiology and clinical purposes. The classification aims to standardize classification of diseases and other health problems so than there is standardization in the usage. The 11th revision is already underway as ICD-10 was endorsed in 1994. But the U.S. is lagging behind the implementation of ICD-10 itself and current estimates suggest that it can be rolled out only by 2015.

Athenahealth, Inc (NASDAQ:ATHN) has ample avenues for growth in this field as the healthcare industry has to transition to the new classification system.

The delay in implementation:

The U.S. is already lagging behind in the implementation and a bill has been introduced to take back the implementation further. The implementation would require a reclassification of the codes and this measure would affect healthcare providers as well as insurers. It is a massive exercise and there are ample opportunities in the field. athenahealth, Inc (NASDAQ:ATHN) is on a mission to build a healthcare backbone so that information and data is available across the industry. It is hosting its offerings on a cloud based platform so that it is not affected by changes in the operating environment. It has more than 50,000 providers on its network.

The company has also tied up with Precyse University to provide on-site, online and mobile ICD-10 education solution. This partnership will allow health providers train their staff and resolve differences in the implementation. The delay in the implementation is already causing heartburn as several organizations have already trained their staff. The laggards are dragging the industry behind.

athenahealth, Inc (NASDAQ:ATHN) will be targeting the laggards and this will also provide it expertise as the next transition to ICD-11 is already on the horizon.





ZirMed Partners with Precyse for Physician Office ICD-10 Education …

Premier health information connectivity and management solutions company offers providers comprehensive ICD-10 training WAYNE, Pa., and ALPHARETTA, Ga. – ZirMed®, a leading health information connectivity and management solutions company, has partnered with Precyse/HealthStream to offer its clients a powerful and unique ICD-10 education program for the physician office/ambulatory market …

ZirMed Partners with Precyse for Physician Office ICD-10 Education …

WAYNE, Pa., and ALPHARETTA, Ga., March 13, 2014 /PRNewswire/ – ZirMed®, a leading health information connectivity and management solutions company, has partnered with Precyse/HealthStream to offer its clients a powerful and unique ICD-10 education program for the physician office/ambulatory market. Precyse and HealthStream have teamed together to offer a unique and comprehensive ICD-10 …

ICD-10: Ready or Not? | ACCCBuzz

by Amanda Patton, Manager, Communications, ACCC

Calendar pages and clock While the granular detail offered by ICD-10 may seem daunting and even excessive—as highlighted recently in the Washington Post’s Wonkblog,  “When Squirrels Attack! There’s a Medical Code for That”—the move has been a long time coming. (Implementation was originally scheduled for 2008 and has been postponed twice.)

All signs suggest that this time, the Centers for Medicare & Medicaid Services (CMS) is not going to blink. The agency says ICD-10 implementation is on course for Oct. 1, 2014.

Last week, CMS Administrator Marilyn Tavenner, addressing the American Medical Association’s National Advocacy Conference, urged physician practices to volunteer for “end-to-end” testing.

In its MLN Matters series, the agency said it will offer some testing services in May and full end-to-end testing to a small sample group of providers in late July.

With Oct. 1 just a little more than six months away, ACCCBuzz talked to Oncology Issues’s Compliance columnist Cindy Parman, CPC, CPC-H, RCC, about what cancer centers  should already have crossed off their “To Do” list and what still remains to be done.

What should be done by March 2014?

Parman: At this point, cancer centers should have:

  • Completed awareness training (the “ready or not, here it comes” session) and selected a cross-functional implementation team. Ideally, you have a “champion” or “champions” who will lead the transition to ICD-10:

-A physician champion taking the lead on documentation improvement

-An  IT champion for software issues

-A medical coder champion to be an onsite expert, etc.

  • Finished the gap analysis and workflow review, and established a plan to make changes where necessary. (You may have needed to re-think how diagnosis codes are currently assigned and which personnel should be performing the medical coding.)
  • Identified all systems that will be impacted and prioritized these for software and/or hardware upgrades.
  • Reviewed physician documentation and scheduled education for documentation improvement. Ideally this education has already started or even been completed—you don’t have to wait until ICD-10 is fully implemented!
  • Set up an initial budget to include all transitional costs and established a training plan.

What do cancer centers needs to focus on between March and October 1, 2014?

Parman: Centers need to:

  • Continue to pay attention to complete and accurate medical record documentation.
  • Keep up ongoing communication with internal and external vendors to ensure that end-to-end testing is completed and any issues detected during testing are addressed immediately.
  • Revisit and revise the budget for system upgrades, coding education, etc., as needed to account for any unexpected costs.
  • Implement your previously established training plan to ensure that the cancer center has enough trained medical coders or other personnel who can accurately assign ICD-10-CM codes following the guidelines for this code set. Some facilities are performing “dual coding” (both ICD-9-CM and ICD-10-CM) to determine if there will be a need for temporary staff to help out during the months immediately following the transition.
  • Review Medicare Local Coverage Determinations (LCDs) and other payer policies to determine any updates in medical necessity criteria, payer requirements for diagnosis codes, etc.

Then, you can sit back and know your center is prepared for the biggest change to the diagnosis coding classification in decades!

Resources for ICD-10 implementation are available on the American Health Information Management Association (AHIMA) website here.

Timing is no longer a question in ICD-10 training | Healthcare IT News

We’re past the point that we can debate the timing of ICD-10 training. Start ICD-10 training now.

It’s that simple.

Maybe actually training your staff to document properly and assign the right medical codes is a bit more complicated. OK, it is. The American Medical Association’s (AMA) free educational resources has a fairly nice outline for planning your ICD-10 training. Throw in some tips from the Centers for Medicare and Medicaid Services (CMS), you have a really good start.


Identify staff members (including clinical staff ) who need training on ICD-10

And you need to decide the level of training needed for each staff member. There are three levels of training that need to be planned:


  • ICD-10 code training


    • Medical coders


      • ICD-10-CM/PCS code set

      • Anatomy and physiology refreshers

      • In-house trainers


        • Medical coder with ICD-10 training

        • Train co-workers

        • Skills:


          • Public speaking skills

          • Comfortable with change and learning

          • Ability to organize and plan training sessions

          • Desire to do more than coding

    • Dual coding


      • Assign ICD-9 codes and ICD-10 codes before Oct. 1, 2014

      • Advantages:


        • Medical coders can practice their ICD-10 knowledge

        • Clinical documentation deficiencies are exposed

        • Extensive internal and external testing can be done

    • Non-coding staff members


      • Educate IT staff about requirements and structure of ICD-10 code sets

    • Coding champion


      • Staff member with ICD-10 training

      • Educate and create awareness among the non-coding staff

      • Help understand what vendors are selling

      • Plan implementation and testing

  • Awareness


    • Start immediately

    • Where to start

      Source: Overlooking Little ‘C’ Coders Puts ICD-10 At Risk


      • “Patient Registration”

      • “Central Scheduling”

      • “Utilization Review”

      • “Quality Improvement”

      • “Ancillary Departments: Lab, Rad, Respiratory, Etc.”

      • “Infection Control”

      • “Patient Accounting”

      • “Dietary”

    • Create an education plan that fits their schedules and needs


      • Explain how their work with ICD-10 codes will affect reimbursement.

      • Assess what they need to know:


        • Major differences between ICD-9 codes and ICD-codes

        • ICD-10 cheat sheets

    • Regular communications with management, IT staff and medical staff about:


      • Differences between ICD-9 and ICD-10 code sets

      • Differences between ICD-10-CM and ICD-10-PCS code sets

      • Regulatory requirements

      • Value of ICD-10 code sets

      • How ICD-10 implementation works with other initiatives

      • Impact on coding productivity and accuracy

      • Budget impacts

      • How the transition will impact departments

      • Impact on physicians’ time

      • How ICD-10 coding could affect patient encounters

      • Updates on progress of the ICD-10 transition

    • Recruit physicians and other clinicians to help champion your ICD-10 project. This has two key benefits:


      • Physicians and clinicians will be more influential in getting colleagues to cooperate. Which will come in handy when they learn they need to add more detail to documentation.

      • Physicians and clinicians can offer reality checks to how things really work in your practice. Something that the IT staff or consultants may not be aware of.

    • Consider expanding their coding skills and knowledge to make up for lost productivity.

  • Procedural training


    • New procedures and systems


      • How to use new software and tools


        • Electronic health records (EHRs)

        • Computer assisted coding (CAC) systems

        • Practice management systems

      • New forms such as superbills

      • New billing and claims procedures

      • New documentation procedures

    • Clinical documentation improvement (CDI) initiatives


      • Impact on documentation

      • CDI strategy


Identify an office expert on ICD-10

This could be a physician, medical coder, administrative staffer or consultant. You need someone who understands the ICD-10 code set and what needs to be adapted.

If this expertise doesn’t exist in your medical practice, then hire a consultant or send someone to ICD-10 training ASAP.


Create a training plan

These questions will help plan ICD-10 training:


  • “On which ICD-10 code sets do we need to receive training: ICD-10-CM (diagnoses), ICD-10-PCS (inpatient procedures), or both?”

  • “Who should be trained on the ICD-10 code set?”

  • “How long will it take to train the staff?”

  • “Which training method will work best for our staff: classroom training, web-based training, written materials, or hiring a consultant? Why is this the best method?”

  • “Would a “Train the Trainer” system (i.e., one staff member receives training, then trains the rest) work for our staff? Why or why not?”

  • “Where can we obtain the training?”

  • “Will there be downtime during the training? If yes, approximately how long? What action will we need to take?”

  • “What resources do we need to support the staff after training?”

  • “When should training be completed?”


Begin staff training

Not everyone needs to know everything about ICD-10 coding. Start preparing personnel for what they need to know and get them scheduled for the right training.


Complete staff training

Actually, I’m going to disagree with this one. Training will probably never end. At least keep physicians actively thinking about clinical documentation.


Incorporate ICD-10 training into new employee orientation

Basically, don’t assume everyone knows what it takes to be ICD-10 compliant.


Implement monthly or quarterly ICD-10 review sessions after training is complete

Maybe this is why I don’t think ICD-10 training is complete.

If you start your staff on a steady diet of ICD-10 and documentation training, you can keep them engaged through the rest of the year. Then they will not forget what they learn. But the key is to start now.

5 Best Practices for ICD-10 Physician Education From Crozer …

Crozer-Keystone Health System ICD-10 preparation leaders discuss their physician education strategy.

When physicians who haven’t received ICD-10 training hear the upcoming conversion mentioned, you can see fear in their faces, says Joanna Lucas, ICD-10 committee chair and senior administrative director of health information management/care management at Crozer-Keystone Health System in Springfield, Pa.

CKHS logo“They get this sort of deer-in-the-headlights look,” she says.

However, she says Crozer-Keystone — a five-hospital, nonprofit health system located in Southeastern Pennsylvania — has found a way to ease that fear and keep physicians from freezing in the path of the oncoming ICD-10 transition: thorough and customized education.

“They realize they don’t have to be coders,” Ms. Lucas says. “They just have to document with specificity. That really takes the fear of it away.”

A small group of people who have specific ICD-10 training have met with physicians one-on-one and in groups to explain the new system and to give physicians a sense of calm and clarity surrounding the transition. Here are five best practices they identified for physician education in preparation for ICD-10.

1. Make information easily accessible online. Although in-person meetings are a significant part of Crozer-Keystone’s approach, the system has also devoted a section of its website to ICD-10. It includes links to educational resources such as the American Medical Association’s ICD-10 Center. It also has a section devoted to clinical documentation improvement tips.

“We provide information for providers including tips of the month, which inform them of the documentation concepts that will be required in ICD-10 pertaining to particular diagnoses,” Eileen Garrity, manager of Crozer-Keystone’s CDI program, says of the website. 

2. Schedule short meetings with small groups. Concerning in-person educational meetings, Ms. Garrity says it’s crucial to be considerate of the physicians’ time. At Crozer-Keystone, they schedule ICD-10 training meetings to run for 30 minutes, although physicians can opt to stay longer. “The half-hour scheduling is huge because it shows a respect for their time,” Ms. Garrity says.

Additionally, she and others involved in the training efforts find it’s best to address no more than three physicians at a time, although residents and fellows are usually trained in larger groups.

“With the time constraint, three is an appropriate number,” she says. “They have ample time to ask questions.” 

3. Tailor educational meetings to each physician group. Addressing physicians in small groups also allows Crozer-Keystone to customize the meeting materials for particular physicians. The ICD-10 trainers address the top 10 diagnoses for the physicians in the meeting depending on their specialty, says Marlowe Schaeffer-Polk, D.O., JD, physician adviser for two hospitals within the Pennsylvania-based system: Delaware County Memorial Hospital in Drexel Hill and Taylor Hospital in Ridley Park.

“I think that’s been tremendously helpful,” Dr. Schaeffer-Polk says. “It’s a very well-directed approach toward each particular specialty and subspecialty.” 

4. Show the impact of correct documentation. Another important aspect of training involves presenting hypothetical, real-life situations, such as a patient showing up to the emergency room with a certain condition and showing physicians how their reimbursement for the case would differ if they didn’t make any changes to their documentation in line with ICD-10.

Dr. Schaeffer-Polk says this helps physicians understand how taking the time to mention which side of the body an injury was on or the root cause of the condition can make a big difference in payment. However, she emphasizes the system is not in any way teaching physicians to “upcode,” or indicate a higher-intensity service than appropriate. “If it’s well-documented, you will receive the appropriate reimbursement,” she says. 

5. Don’t worry about educating too much, too early. Overall, Ms. Garrity advises jumping in without hesitation when it comes to training physicians for ICD-10. “There’s a lot of information out there now where they say you shouldn’t educate too early,” she says. “It’s very important to get them used to it now, so on Oct. 1 it’s not like we’re flipping a switch. The more education they receive the more comfortable they’ll be with it.”

More Articles on ICD-10:
5 Key CMS Resources for ICD-10 Preparation  
5 Recent Stories on ICD-10  
CMS Launches Online ICD-10 Tool for Small Practices 


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Key Ways to Help Physicians Transition to ICD-10 | Physicians …

The ICD-10 transition on October 1 is quickly approaching. Is your practice prepared? Perhaps a better question is: Are your practice’s physicians prepared?

Under ICD-10, health systems and physicians are going to experience “an absolute explosion of the requirements for precision and specificity” in documentation.

That’s according to Thomas Mercer, president and CEO of Executive Health Resources, a provider of compliance solutions to hospitals and health systems, who spoke about the ICD-10 transition challenges health systems will face during a presentation as part of this year’s Healthcare Information and Management Systems Society (HIMSS) Conference in Orlando, Fla., entitled “Using Documentation Technology to Achieve Physician Alignment with ICD-10.”

Under ICD-10, the number of codes used for documentation and coding will jump from about 18,000 to almost 155,000, said Adele Towers, Mercer’s co-presenter and medical director of health information management at the University of Pittsburgh Medical Center (UPMC). For a more specific example of how that increasing complexity will play out, consider an ankle sprain. Under ICD-9, an ankle sprain has four potential diagnosis codes. Under ICD-10 it has 72. The key will be practices and physicians learning the codes that apply to their specialty versus memorizing all 72 which may not apply.

But increasing complexity is still likely to result in a drop in productivity as coders adjust, and as physicians receive more queries about documentation, said Towers.

To help ensure coders and physicians get up to speed at UPMC as quickly as possible, the health system combined a computer-assisted coding solution and a clinical documentation improvement system at three of its hospitals in October 2013.

The goal: to use technology to help identify the clinical facts based on the documentation that is present, and to use technology to help identify what’s missing. Rather than relying on manual queries to physicians when coding and documentation questions crop up, the new system sends queries to physicians and it enables them to complete the queries electronically with an EHR interface.

“You can do all of the excellent education in the world, you can do all of the coaching in the world, but if you’re not making it easy for the physicians to respond to the queries in an intelligent way where they’re confident in the response, it will not be nearly as effective,” said Mercer.

The results of the new system include:
• Faster responses to queries. The response rate among physicians jumped from around 70 percent to nearly 100 percent at the three hospitals that transitioned to the new system.  
• Faster turnaround for queries. The average query turnaround time decreased from 15 days to 16 days to about six days to eight days at the hospitals.  
• Faster coding turnaround time to final bill. Turnaround time to final bill for cases with a query decreased from 29 days to 39 days at the hospitals to 10 days to 14 days. 

While technology can help ease the transition for physicians and practices, so can education, said Mercer. “We need to continue to work to educate physicians about what documentation in the new world really means,” he said.

To ensure physicians have relevant coding and documentation information at their fingertips, UPMC has created a series of brief videos featuring physicians. In the videos, physicians provide documentation information on disease areas so that physicians can learn directly from their colleagues.

“I think the key with physicians is … one method is not going to work for everybody,” said Towers.  “Some physicians like the videos, some physicians just want a pocket card, some physicians demand to have everything on the query form … We provide it all.”