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INTEGRATING ICD-10 IN YOUR PRACTICE
• Training and clinical documentation improvement
• Payer engagement and readiness
• Denial management
• Data warehouse and reporting
Along with having a balanced approach to remediation, it is
important to have the right people involved, especially since
ICD-10 conversion will affect essentially every role in an organization.
Every person in the practice needs to know how
ICD-10 will affect their daily routines. Establishing an overall
ICD-10 leader and leads for each of the work streams above is
ideal, and for many leads this responsibility should fall under
their current role in the practice as business offıce manager,
coding lead, trainer, etc.
To gain the leadership and fınancial support needed to be
ICD-10 ready, it is important to have a physician champion
and involve practice leadership in planning, risk mitigation,
and education events to be prepared for the effects of ICD-10.
Engage physicians and clinicians to understand how improved
documentation will be required as part of being
ICD-10 ready. Creating awareness across departments on
codependent readiness tasks is needed to ensure that the
right people are working together on tasks like workflow
readiness, claims edits/rules remediation, reduction of unspecifıed
codes, end-to-end testing, etc.
When practices work together on large transformations
like ICD-10, it is a great opportunity for practice staff to collaborate
across functional areas and learn how they are all
dependent on each other to provide care to patients and
maintain a high-performing revenue cycle process. Because
of the duration and complexity of migrating to ICD-10, having
an integrated project plan, ongoing issue and risk management
process, and change management plan have been
essential to managing decision making and change over an
extended timeline. Much of ICD-10 readiness is risk mitigation
for assurance that after October 1, 2015, the effect is minimal
and a steady-state can be achieved soon after.
ENGAGEMENT AND ONGOING COMMUNICATION
Awareness throughout a practice on ICD-10 conversion (i.e.,
why, when, and how) needs to be continuous and widespread.
Conversations on ICD-10 need to be part of weekly
meetings of all teams, and regular round table meetings with
the ICD-10 work-stream leads need to occur to be able to
follow through on an integrated plan with strong codependencies.
Every practice’s culture is different and effective
communication methods will vary; always be sure ICD-10
conversion is part of the conversation and every planning
session. Team with your physician champion to keep ICD-10
at the forefront of conversations with his or her colleagues.
APPLICATION AWARENESS AND TESTING TO
VALIDATE READINESS
Every application that contains and utilizes diagnosis codes
in a practice will be affected by ICD-10 and will need to be on
an ICD-10–compliant version and tested before conversion.
Practices need to target their electronic health record (EHR),
practice management system, laboratory information system,
radiation oncology information system, claim scrubber,
and any other application that carry codes for remediation.
Mapping out systems affected, along with interfaces and application
version required, is a basic fırst step to know what
will need to be remediated and ready for conversion. Spend
the time to keep in regular contact with application vendors
to know what is required and has changed as the vendor also
prepares for ICD-10.
Preparedness for ICD-10 requires more than just having
each application on an ICD-10–compliant version. Applications
need to be tested end to end in a nonproduction (i.e.,
live) environment before activating ICD-10 codes on October
1, 2015. This testing is essential to identify major defects,
issues, and workflow that need attention from the point of
documentation in the her, to the practice management system
through the claim scrubber, and then clearinghouse to
the payers and back. Ideally, a practice would have a chance
to participate in acknowledgment and end-to-end testing
with Medicare by teaming with a Medicare Administrative
Contractor (MAC). End-to-end testing MACs and private
payers often only target select providers, which limits end-toend
testing opportunities for many practices. Practices need
to test early and often to minimize the potential risk of activating
ICD-10 code across all applications on October 1,
2015. The Nachimson Advisors Study on ICD-10 readiness
estimates ambulatory practices will spend $4,300 to $9,600
per physician on application end-to-end testing efforts and
guidance. 9
TRAINING FOR ALL PERSPECTIVES AND CLINICAL
DOCUMENTATION IMPROVEMENT
Because of the diverse effects of ICD-10, training needs to be
widespread and encompassing to ensure all practice staff are
clear on how ICD-10 will affect their work environment.
When determining who needs training, consider targeting all
physicians, advanced practice providers, nurses, medical assistants,
radiation therapist, coders, all business offıce staff,
front-offıce staff, and any other staff members that are dependent
on diagnosis codes. The Nachimson Advisors Study
estimates practices will spend $480 to $1,000 per physician
on training of staff and themselves. 9 This cost varies by practice
size and type of training and does not include the cost of
physicians’ and staff’s time. The study also estimates a physician
will need an hour of documentation training, which
will likely be the minimum, and training for coding and other
staff will be much more time consuming.
Utilize a mixture of training methods to help meet the different
learning needs and challenging schedules of providers
and staff. Consider attending boot camps to set aside dedicated
time for those who will be affected the most. Providing
access to eLearning, podcasts, and illustrations of common
diagnoses can help make learning more on demand and
accessible. Many coders are looking to become ICD-10
asco.org/edbook | 2015 ASCO EDUCATIONAL BOOK
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