Physician Practice

Preparing for ICD-10; it's coming, ready or not

Physician Practice Insider, June 2, 2015

As October 1 draws closer and closer for the implementation of ICD-10, the remaining resistance by some physicians and their advocates, such as the American Medical Association (AMA), appears to be slowly waning.

The AMA still supports new legislative efforts to derail ICD-10
, arguing physicians have enough on their plates between implementing electronic health records (EHR) and new payment and delivery models. At the same time, the organization is providing training tools for physicians to prepare for the changeover.

Certainly not all physician practices and their business associates are opposed to the change. The big question that remains is whether all of the players will be ready on October 1.

Yvonne Moncovich, SPHR, CPC, CPCO, the operations director at Straightline Medical Billing in Wilmington, North Carolina, is in favor of ICD-10, and her company provides ICD-10 training to physicians.
“It brings us in line with the rest of the world (that uses CPT® codes) and will provide better data,” Moncovich said. “In some cases the coding will be easier because one code better describes comorbid conditions which required multiple codes under ICD-9.”
“Since we work with multiple practices, there is no single answer to how they are preparing,” she said. “Some are working on internal processes to be ready and some feel their EMRs [electronic medical records] are going to resolve all of their problems.”
Most practices will only be about 75% ready to deal with ICD-10 though, estimates Norma Fowler, the practice manager at Advanced Gastroenterology in Union City, Tennessee.
“We have had a long time to review and study for ICD-10; however, we all procrastinate and wait until the last minute,” Fowler said. “Physicians will mainly have a lot to learn. Most offices will have software in place to see what ICD-9 codes were used and bill out ICD-10 at the time of the visit.”
Clinicians and hospital administrators have also been speaking up about preparedness and the importance of switching to ICD-10.
In a blog series for Hospitals & Health Networks Daily, Linda Reed, RN, a vice president and chief information officer at Atlantic Health in Morristown, New Jersey, writes that healthcare providers are quickly running short on time to adequately prepare for October 1.
She says system upgrades, configurations, testing, financial assessments and appropriate staffing for coders should have already occurred, just leaving “the easy stuff” to do—training the people who will work with the new codes. In some cases, she points out, if a provider is just gearing up now, it may already be too late to meet the deadline.
ICD-10 training tools can be expensive for independent physicians, Reed acknowledges, but says there are numerous free tools available from CMS, the World Health Organization and other groups.
Thomas Selva, MD, the chief medical information officer at the University of Missouri Healthcare told HealthLeaders Media that hospitals and physicians have to get on board.

“We've got to do this [ICD-10]. The reality is, we don't have enough specificity in our code,” said Selva. “Look at orthopedics, they're crying for more specificity in their codes. There's no room left in ICD-9, and in all honesty, we are very late to the party.”
In regard to relying on EHR vendors to provide the solution to ICD-10, that’s a recipe for disaster for physicians, according to Moncovich, and one she blames the vendors for proliferating.
“I blame a good bit of that on the EMRs who are selling cross-walking services as though everything will be a one-to-one match,” she said. “I sat in on a webinar which was basically called ‘you don't need to know ICD-10 for orthopaedics.’ It was a joke, but I'm positive there are ortho practices out there who will sign on the dotted line because this major EMR is promising them no preparation required.”
Moncovich knows physician practices that were ready last year when ICD-10 was slated to roll out, but also knows others that won’t be ready by October 1. The big difference will be time and money, she said—practices that are prepared will spend less time than others translating codes on October 1 and receive prompt payment instead.
As an outsourced billing company, Straightline is training its own staffers on ICD-10 so they understand the coding structure and sections that apply to their multi-specialty clients, Moncovich said. There’s an American Health Information Management Association (AHIMA)-approved ICD-10 trainer on staff, and the certified professional coders are acquiring their ICD-10 updates as well.
She said her firm is monitoring the seven billing clearinghouses it deals with and more than seven electronic records systems used by clients to ensure both clearinghouses and EHRs will be ready to transmit ICD-10 claims to insurance carriers on October 1. At the same time, there’s a great degree of uncertainty whether all insurance carriers will be ready for ICD-10 in time. As a result, Straightline and other companies may still have to submit some ICD-9 claims after October 1 to any carriers that don’t make the switch by the deadline.
That’s a concern shared both by Fowler and Debbie Schulz, the practice administrator at Northwest Pediatric Gastroenterology in Portland, Oregon.
“Our biggest worry is the insurance companies,” Schulz said. “We have a fairly small body system in gastroenterology, we do have some crosswalks we have made and we did purchase a feature in our EMR that will allow you to put in a description and/or the ICD-9 code and it will convert it to the ICD-10.”
She adds: “We hope that the insurance companies get it together before October 1.”

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