There’s been a lot of talk about the run up to Oct. 1, when ICD-10 will be a reality for healthcare providers around the country. But what happens on that specific day and in the days, weeks, and months to follow?
Ron Sterling, president of Silver Spring, Md.-based Sterling Solutions, has five pieces of advice for physician practices that want to thrive with their EHR in the ICD-10 world.
Ensure staff are trained to make ICD-10 changes
The first thing is to make sure that your staff are trained to make adjustments for ICD-10 to your EHR, said Sterling “On September 30, your practice will likely be in an ICD-9 world,” he said. The very next morning, a Thursday, you’ll be living in an ICD-10 world. “You’ll need to think about how your practice management system works with your EHR. You’ll need to think about claim edits based on the ICD-9 world, and how you work with your clearinghouse,” he said.
Work closely with your EHR vendor
Pay attention to any software updates to your EHR after Oct. 1, and make sure you apply any ICD-10-specific fixes to your EHR as soon as possible, said Sterling. He noted that CMS has a lot of information available on ICD-10, still he recommended that physician practices tap their EHR vendors for advice as well. However, those ICD-10 guidelines won’t be specific to your area of practice. EHR vendors may give you general information on their system, but that won’t be information that’s relevant to you in terms of your area of medicine, he said.
Setting up treatment plans within the EHR
Many EHRs get to the subjective and assessment part of the patient encounter and automatically choose the ICD-9 code, which will present a list of commonly used treatments and drugs. To keep a patient well in the ICD-10 world, you’ll need to provide more granularity for those areas, said Sterling. What will help with that is creating more specific treatment plans within the EHR.
Working with other providers
Whether it’s a prescription or a referral to another physician or scheduling a surgery date, practices should plan ahead with other providers in terms of their plans as of Oct. 1. All of the prescriptions, referrals, and surgery dates set before Oct. 1 will need to be converted to ICD-10, otherwise patients will experience a delay in receiving their medications and surgeries may need to be rescheduled.
Recoding claims for ICD-10
If your EHR and practice management system are integrated, you will need to think about claim edits on the morning of Oct. 1, said Sterling. “You will need to figure out how those claims will translate in the ICD-10 world,” he said.
This matters in the short term, but even more so as leniency on processing ICD-9 claims backs off. Sterling noted that payers will vary on how strictly they manage claims after Oct. 1. From an operational perspective, it’s good to keep in mind that anything in process on Sept. 30 could require recoding to ICD-10, said Sterling.
Over the longer term, your practice should focus on the specific information you’ll need to capture within your EHR to substantiate a Level 4 office visit, he said. Payers will be looking for more justification for those claims after Oct. 1.