Regina Kraus, an expert on Health Information Technology programs and a member of the American Health Information Management Association (AHIMA) and the Ohio HIMA, as well as a board member of the Miami Valley HIMA, said that there are many steps that medical groups and physicians should be taking, especially in testing and training, to be prepared for the ICD-10 compliance deadline.

Among them, says Kraus, is that physician groups need to conduct a “practice inventory” to determine if they have the necessary resources in-house or if they should consider collaborations, outsourcing or a software purchase. She sat down with The Progressive Physician to talk about ICD-10 preparedness.

Q: What questions should physicians be asking themselves as the ICD-10 deadline approaches?

A: Providers at small practices need to build their action plan. This includes reviewing issues such as:

• Most hospital-based practices are anticipating a 50% decrease in productivity, so be aware of the time issues involved in accurate coding.
• What about personnel? Are you prepared to train current staff, hire new staff, or outsource your coding needs? Encourage coders/office manager to join coding and billing organizations to have the best access to information and training materials. Most hospitals have separate physician offices that offer training to their office staff. Consider training in-house staff. There are many opportunities available for enhancing your billing and coding staff.
• If the practice chooses to keep the coding and billing in-house, consider it a valuable and important investment and asset. What is the practice willing to invest to stay in control of their billing and reimbursement? Do you have staff currently on board that can meet the challenge? The first step would be to look at your current staff and identify who can or is willing to step up to the challenge.

Q: What obstacles or possible setbacks might care providers encounter while preparing for ICD-10?

A: A lot will depend on the size of practice, number of patients, physicians, dollars, etc. Some practitioners may choose to outsource their coding needs to a third party and not deal with trying to manage the transition in-house. That is fine, but be aware of the environment out there.

Many vendors are “keen” on promising much but delivering little. Choosing a coding vendor is no different or less important than any other third party vendor you may select. Check out your resources and ask for recommendations. See what other comparable practices are doing.

Another obstacle is the shortage of trained and available coders, depending on geographic location. Stiff competition exists for coders with hospitals offering sign-on bonuses and the option of remote coding positions. This is another reason to look at collaborations in your geographic location or the option of outsourcing.

Additional obstacles include the need for dual-coding. Many hospitals have started with this process of billing or coding for both ICD-9-CM and ICD-10-CM at the same time. Their billing systems can identify issues and problems with codes and documentation before the bill is dropped.

Can physician offices do the same? It may be more possible than you would think.

Q: Dual coding is suggested for the billing and coding workforce in anticipation of ICD-10. Physician practices should dual code and audit their charts for coding accuracy, the necessity of codes, and their documentation. What can an audit include?

A: An audit could include the following:

• Are the codes you have for your patient all necessary and current? The more codes that you have, the more codes need to be converted over to ICD-10.
• Pay attention if you have a lot of patients coming in from the acute care setting and you are treating patients in the post-acute care setting.
• What does your documentation indicate? Does it support the more specific ICD-10 code?
• Documentation needs to be reviewed for disease specificity, acuity, laterality, if applicable, disease stage, etc.
• Physicians need to consider if they are documenting to the level of specificity needed for a given specialty. Example: Your patient is diagnosed with Generalized Anxiety Disorder. Are they still being treated for that? Does the patient exhibit signs and symptoms of the disorder? They were prescribed anti-anxiety pills 10 years ago. Is it still an issue?
• Look at your NOS (not otherwise specified) and NEC (not elsewhere classifiable) codes. With ICD-10, some of those go away or you may need a much more thorough diagnosis/specific diagnosis with ICD-10.
• ICD-10 allows payors to target what they will and will not cover, so pay attention to the coverage determinations of your local insurance plans.

Q: What resources are available for care providers?

A: There are many resources available for care providers, including many reputable educational resources such as American Association of Professional Coders (AAPC) and American Health Information Management Association (AHIMA), and of course, the Centers for Medicaid and Medicare Services itself. In looking for resources (publications), make sure you are purchasing reputable information from a reputable source (CMS, AHIMA, etc.).

Q: What will healthcare most likely look like after ICD-10 is implemented?

A: The needs for healthcare billing, reimbursement, and retrieval of data will demand a much more precise and accurate coding and billing system Health insurance claim rejections are anticipated to be on the rise as both providers and payers “tweak” their billing and reimbursement systems. Hospitals are already dual-coding and running edits on their “anticipated” rejections. Clinical Documentation Improvement (CDI) specialist is one of the fastest growing non-patient related fields, usually held by nursing.