Plan, Prepare, Perform!

Can you believe it…the ICD-10 October 1 transition is just a few short months away?

If you haven’t started your ICD-10 preparations, testing, and training yet, the time to start is now!

Recently I had the opportunity to sit down with Lori Albano, Manager of EDI Desk Support at NextGen Healthcare, to discuss the impending ICD-10 transition.  Lori is a credible resource on the subject – she is heavily involved in ICD-10 training and implementation.  More specifically, she works with our own NextGen Healthcare clients to complete the ICD-10 setup along with their applications. She also assists with claims testing, develops end-to-end testing plans, and coordinates clearinghouse testing.

When asked why some practices may be delaying the much-needed ICD-10 transition, Albano offered some advice we all can follow, “Hope is not an option!”

And based on our research from CMS, the AMA site, and communications from Congress, everything is, in fact, still pointing to October 1, 2015 as the ICD-10 deadline.  That means if you don’t get on board soon, you won’t get paid come October 1!

Don’t delay your ICD-10 transition any longer!  You can start preparing your healthcare system or practice by considering some helpful tips on ICD-10 training best practices.  Here’s what Lori Albano had to say on the subject:

NextGen Healthcare (NG):  Who do you recommend take charge of a practice’s ICD-10 training testing project?

Lori Albano (LA):  It’s hard to choose just one person.  What I’ve seen that typically works well is to have someone from each area of the practice represent on the ICD-10 panel and the reason for that is, different from the 4010 to 5010 conversion, ICD-10 impacts every single area of the practice. It’s good to have someone from appointment scheduling and referrals, anybody that deals with advanced beneficiaries notices for Medicare, your clinical staff, and of course billers and coders.  It’s helpful to have someone from each area because that person brings to the table something different that say, a practice manager, may not think of because they aren’t in the weeds on a daily basis.

NG:  What should be the number one priority for end-to-end ICD-10 testing purposes?

LA:  It’s challenging to narrow it down to one thing. From a physician side, it will be clinical documentation.  This will be significantly different and more extensive for the physicians.  For coders, obviously the priority will be learning the ICD-10 code set.  For your billers, office staff, and some of your clinical staff, learning the 10 codes they are going to use on a daily basis, and becoming familiar with the terminology and what’s required with the documentation, will be crucial.

NG:  What educational materials do you recommend our clients and non-clients utilize during ICD-10 testing?

LA: For our NextGen Healthcare clients, we offer the ICD-10 forum every Wednesday along with our ICD-10 Webinar Road Map Series, 3M™ ICD-10 Education Program, and ICD-9/ICD-10 Comparison Utility Tool. The CMS site also is a helpful resource. CMS hosts webinars and communicates information for small physician groups, for medium-size, and for large hospital systems.  If you’re a member of WEDI, they have some great materials and so do HFMA and MGMA. The biggest thing is, if people are a member of any kind of healthcare group they are going to have available resources out there for their members, in addition to what we have offered at NextGen Healthcare and what CMS has… and clients should take advantage of these educational offerings.

NG:  How much time is adequate for an ICD-10 training period?

LA:  It depends on the size of the practice.  The best way to attack it is by phases, so to speak.  For example, if you have a small one-or two-doctor practice then three to six months is acceptable; for a large multi-specialty practice, more than six months would be necessary.

NG:  Do you think providers/practices have a clear understanding of their responsibilities for the ICD-10 transition or are some people still in the dark?

LA:  I think some are still in the dark. Again, our NextGen Healthcare resources for ICD-10 along with CMS offerings … there are so many resources that are free not just for our clients but for anyone to access. More education and more preparation are needed and part of that is due to clients and physicians thinking this is not going to happen.  We have a saying, ‘sticking your head in the sand in not an option. Hope is not an option.’  You have to be prepared because this is going to happen and we don’t see a delay happening again.  Like I said before, this impacts every area of the practice.  This is everything.  It’s huge.

NG:  How can providers best prepare for their billing vendors?

LA:  With their software vendor, obviously, they need to test, set up, and be ready ahead of time.  In working with our clients, they’ll say my clearinghouse said they already tested with a NextGen Healthcare provider; and the way I respond is by asking, “do you know that your set-up is exactly like that provider?”  I ask myself, if it were my money coming in the door, what would I want to do? I would want to test my claims with my set-up to make sure that I’m good to go.  So my advice is this:

  • Complete the set-up in a non-production, non-live environment and send some test claim files out.
  • Don’t just send claims files out with ICD-10 codes (because that is not what they are going to send to the Clearinghouse on a daily basis). We also encourage clients to send files that contain claims with 9-and-10 codes because that is what they are going to do come Oct. 1.
  • We also try to “break” the system; meaning that after Oct.1 one claim should have 9 or 10, but not both.  But what happens if a claim gets out the door with both code versions? We want to make sure that claim stops either at the clearinghouse or, if they submit direct to a payer, that the claims stop directly with that payer.  We don’t want it to go through the adjudication cycle.

NG:  Can you recommend an ICD-10 timeline to put in place for testing?  Perhaps, Steps #1-4.

LA: If we were recommending Steps #1-4, they would be:

  1. Decide who is going to be included from your team.  Pick someone from appointments and referrals,  ABN, billers, clinical staff, etc.
  2. Do a training assessment with your employees before starting ICD-10, and then do one midway through and one at the end of training.  This way you can gauge how far you’ve come and how far you need to go.  In regards to timeline, do those two things first.  Incorporate training for all of your staff.  Develop crosswalks specific to your specialty/practice  (the NextGen ICD-9/ICD-10 Comparison Utility can assist with building crosswalks).  Engage your staff in training and implementation of ICD-10.
  3. Then talk to your vendors, make sure that software is ready, and your trading partners are ready to accept test claims. You want to do a basic training with your physicians and billing staff (*See NextGen 3M™ ICD-10 Education Series Modules)
  4. Lastly, you’ll want to do a final round of End to End testing before you go live.

NG:  How crucial is it for providers to make sure their EHR software is up to date even before this training process begins?

LA:  This is huge… it’s because that is where their physicians eat, breathe, and sleep. For one thing, they’ve got to make sure their software vendor is ready.  Secondly, they’ve got to get the training out there for physicians so that come Oct. 1 the physician’s productivity doesn’t stop.  That’s the biggest thing. Come Oct. 1 we want to make sure the physicians are rowing like normal.  Otherwise, if they’re not ready, their practice could come to a stop Oct. 1.  That’s what we want to try to prevent.

NG:  Are other providers having successes during their training processes?  What are we trying to learn besides the fact that the claims are being accepted/submitted properly to payers?

LA:  The biggest thing is clinical documentation and proper coding so it prevents any type of audit; to make sure the providers are coding to the highest level of specificity because the codes are more granular.  The 3M training will help to assist the physicians-in selecting the appropriate codes.  And, again, developing those crosswalks ahead of time so physicians and billers can become accustomed to the codes they are going to use come Oct. 1 compared to the codes they use now.  That will just significantly help the practice.

Is your practice prepared?  Help is a click away!

The time to prepare is now with NextGen Healthcare.  Make sure your practice is ready for the ICD-10 transition.

NextGen Healthcare offers a robust level of client support, tools, and services for this complex transition. Because getting this right is essential for timely and accurate payments. Don’t let your cash flow take a hit! Take advantage of our NextGen ICD-10 Tool Kit which includes these helpful resources offered to support your smooth transition to ICD-10.

About Lori Albano

Lori AlbanoLori Albano has more than 20 years’ experience in the healthcare industry.  The past 15 years she has been involved with a multi-specialty central billing office (CBO) and in that position she oversaw 200+ physicians, accounts receivables, claims reporting, claims follow-up, and contract negotiations.

Don’t miss the opportunity to hear Lori speak about ICD-10 preparation and testing at our upcoming February webinar in our ICD-10 Road Map Webinar Series:  “On Your Mark, Get Set…Train!”  It’s scheduled for Thursday, February 26 at 3:00 p.m. EST.  We’ll see you there!