PRACTICE TRANSITION TO ICD10
ADSoyerDO
AAOS Practice Management Committee
AAOS San Francisco February 10, 2012
Disclosures
 AAOS Practice Management Committee 2010-12
IMPLEMENTATION OF ICD10
 Where to begin?
 No US tested model in place for implementation
 Draw on experiences from EMR transition
 Look at experiences from Canada
Challenges to Implementation
 In addition to ICD 10, HIPAA will be updated from
version 4010 to 5010
 Overlap between both
 Will require preparedness for both conversions
Impact of ICD Implementation
 Total Cost Impact Nachimson Advisors, LLC 2008
Small Practice $83,290
Medium Practice $285,195
Large Practice $2.7 million
Total Cost Impact
 Costs Arise from 6 Key Areas
1. Staff Education & Training
2. Analysis of Health Plan Contracts, Coverage
Determination & Documentation
3. Changes to Superbills
4. IT System Changes
5. Increased Documentation Costs
6. Cash Flow Disruption
Staff Education & Training
 Clinical & Administrative Staff will require significant
time to learn new codes
 Learned patterns will have to be re-learned because of
the changed structure and organization of the code set
Business-Process Analysis of Health Plan Contracts
 Assessment of ICD 10 impact on business processes,
including provider health plan contracting
 Health Plans may modify provider contracts to comply
with greater specificity required by the ICD 10 mandate
- adjusting payments accordingly
 Coverage determinations may also be revised in
accordance with new diagnostic codes and additional
documentation required to support patients’ treatment
plans
Changes to Superbills, IT System
 Superbills will need to be changed to support 5x
number of codes.
 Software changes and associated costs to EMR
 IT costs of ensuring compliance of Practice
Management / Billing software and Clearinghouse
Vendors with ICD 10
Increased Documentation Costs & Cash Flow Disruption
 Additional documentation will be required to
support the patient’s diagnosis
- less time for clinical work = decrease in
productivity
 Health plan payments will be changing based on
severity of diagnosis and changes in coverage
 There may be significant changes in reimbursement
patterns disrupting cash flow
Total Cost Summary

Total Cost Summary
Typical
Small Practice Medium Practice
Large Practice
Education
$2,405
$4,745
$46,280
Process Analysis
$6,900
$12,000
$48,000
Changes to Superbills
$2,985
$9,950
$99,500
IT Costs
$7,500
$15,000
$100,000
Inc Documentation Costs
$44,000
$178,500
$1,785,000
Cash Flow Disruption
$19,500
$65,000
$650,000
TOTAL
$83,290
$285,195
$2,728,780
Canadian Implementation Experience
 Implemented in 2001, 12 month trials prior &5 yr
transition period completed in 2006
 4 phase approach (education/training, IT support,
trials, maintenance/ upgrades)
 Lessons to be learned
Dedicated training staff, IT development, Gantt charts
 Differences:US & Canada
Canada has Universal Healthcare
Decisions & funding from one source
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok3_0055
58.hcsp?dDocName=bok3_005558
ICD 10 & HIPAA version 5010
Obstacles to Implementation:
1. to busy with EMR / meaningful use
2. scarce technical resources
3. some payers systems aren’t ready
4. some vendors systems aren’t ready
5. some clearinghouse systems aren’t ready
www.cms.gov › Medicare › Electronic Billing & EDI
Transactions
ICD 10 Timeline
 Step 1- Impact Analysis (3-6 months)
 Step 2-Contact your Vendors (2-3 months)
 Step 3- Contact your Payers, Billing Service &
Clearinghouse (2-3 months)
 Step 4- Installation of Vendor Upgrades
(3-6 months)
 Step 5- Internal Testing (2-3 months)
 Step 6- Update Internal Processes (2-3 months)
ICD 10 Timeline
 Step 7- Conduct Staff Training (2-3 months)
 Step 8- External Testing with Clearinghouses,
Billing Service and Payers (6-9 months)
 Step 9- Make the Switch to ICD 10- Oct 1 2013
www.ama-assn.org/go/ICD-10.
Preparation
 AMA Guide
Identify your current systems and work processes
in which you use ICD 9 including:
- Clinical documentation
-
Superbills
PMS (Practice Management System)
EHR
Quality reporting
Contracts
Preparation
 Talk to your current PMS vendor
Questions to ask:
Can my current system accommodate data format changes
for ICD 10 codes?
Will they be upgrading your system to accommodate
the new codes? If yes, will there be a fee?
When will upgrades be installed?
When will implementation be completed?
Preparation
 Talk to your Clearinghouses &/or Billing service
Questions to ask:
Will they be upgrading your system? If so, When?
When can you send test claims (with ICD 10 codes)
to see if they are accepted?
Preparation
 Talk to your Payers about possible changes to your
contracts from implementing ICD 10
Questions to ask:
Do they plan on re-negotiating contracts? If yes, when?
At time of renewal or prior?
What impact will ICD 10 have on your payment,
medical review, auditing and coverage?
Preparation
 Identify potential changes to existing practice work
flow and business processes
Consider these areas:
Clinical documentation
Superbills
Quality reporting
Preparation
 Identify Staff Training needs
Who gets trained & in which areas?
Develop program with training leader who in turn
trains other staff
Resources:
http://www.ahima.org/icd10/role.aspx
Preparation
 Budget for Implementation costs
- expenses for system changes
- practice business process changes
- resource materials
- training
- consultants
Recommendations
 Use your experience from EMR transition to alter
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workflow & anticipate revenue shortfalls
Access to credit line for implementation costs and
cash shortfalls post Oct 2013
Utilize your EMR vendor & Clearinghouse tech
support- If any doubt in their ability to make
seamless transition, NOW is the time to switch.
AAOS resources ( e.g Gateway program)
Consultant?
Thank You
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