Practice management consultant shares the ‘4 Ts’ for physicians to considerEditor’s note: The Medical News series, “Preparing for ICD-10 Conversion,” began last month with “8 Steps” for physicians to take now. This month, implementing the “4 Ts” is the focus recommendation to facilitate a smooth transition. Even though ICD-10 conversion has been anticipated for many years industry-wide, most physician practices haven’t had the resources or the inclination to start preparing before now. It’s not too late to bring those practices up to speed, said Jennifer O’Brien, MSOD, a practice management consultant with KarenZupko & Associates Inc. “Time is of the essence, however,” she said. “Physician practices need to understand the enormity of this mandated transition that will affect their bottom line.”O’Brien recommends applying the “4 Ts.”Team: Establish a work group for ICD-10 conversion. “The group should be a cross section of the practice, including at least one physician, biller, and clinical assistant, and representatives from other functions in the practice that have diagnosis coding as part of their work, such as a surgery scheduler or ancillary service provider,” said O’Brien. “The practice manager or administrator, someone who has an understanding of the whole practice, should also be included. This will require true teamwork. No one person should be shouldering the bulk of the conversion for two reasons: it’s too much and it’s too risky. If one person is doing almost everything and wins the lottery in July, the conversion will fall apart.”Place a year-at-a-glance calendar in a common staff area so all employees may see the deadlines and target dates, suggested O’Brien.“The group will need to meet regularly,” she said. “Someone should create and be the keeper of a work plan that lists tasks, dates and who’s responsible. We recommend keeping a single work plan so that everyone can see the progress, looming dates, and the specifics of the shared responsibility.”Testing: Communicate with your EMR, Practice Management Software (PMS) vendor, clearinghouse and biggest payors concerning if, when and how testing of claims with ICD-10 will be done. “Medicare has announced that testing will occur the week of March 3-7. A couple of fiscal intermediaries are requiring providers to register to participate in the testing. At this point, there’s no indication of another testing period, so if practices or clearinghouses miss that testing, there may not be another opportunity before October 1. That’s just Medicare; communicate with other big payors to find out about their testing.”Training: Make time for training sessions, both self- and instructor-led.Self-training exercises are available to all physicians, such as running a report of the 25 to 75 most frequently used ICD-9 codes and then crosswalking those to ICD-10. “I have a client who’s pregnant with her first, and due in April,” said O’Brien. “She’s already started on this process to teach herself how she’ll need to code and document differently and is planning on implementing necessary changes before she goes on maternity leave, so that when she returns in the summer, she’s not having to learn and prepare for ICD-10, in addition to adjusting to her new work-life balance.”Specialty societies, state medical societies, hospitals, software vendors and consulting firms also provide ICD-10 training sessions for physicians and staff. “Sign up for those sessions, go to them, listen and learn,” he said. “For most physicians, the dread associated with attending coding training is akin to that of having a root canal. It’s not going to be fun; it may be barely tolerable. Thing is, it’s not optional. In the past, when physicians considered coding training, it’s been for the opportunity to improve their existing CPT and ICD-9 coding, which they’ve been doing for decades. They already have a base fund of knowledge and experience with those two coding systems. This is completely new to everyone. Basic training on how to use the system – look up, differentiate, assign and document codes – is essential for every physician. Everyone is starting at a base of zero.”Tools: Identify all practice tools, processes and systems that use diagnosis codes.“They’ll all need to be converted to ICD-10, and folks will need to be introduced to and trained in their use,” said O’Brien. “At one of the early meetings, have your work team brainstorm to create a list of all affected tools, processes and systems. For example, if the practice contracts with an outside lab, which includes diagnosis codes in its orders form, the lab will likely issue a new form. Creating the list is just to understand the scope and delegate specific assignments so that everything can get done by October 1.”
The following list may facilitate tool identification:
Billing system
Charge tickets
Claims/clearinghouse
Clinical trials/studies
Eligibility
EMR discreet data templates ASC
Encounter forms
Orders (imaging, lab, therapy)
Payment posting
Patient information/history
Prior authorization
Referrals (incoming, outgoing)
Registration
Scheduling
Subcontracted services
Surgery scheduling
Tumor/disease registry
Voice recognition templates
