GLMS PPAC
Business meeting and Part 2 of the GLMS/PPAC Education Series
The Business Impact of ICD-10 – presented by Jessica Williams, Manager Greater Louisville
Medical Society Physician Education & Practice Support
July 12, 2012 7:00 A.M.
Baptist Hospital East
Education Center
Auditorium
Trudi Rash, MD - Chair
WELCOME AND INTRODUCTIONS – DR. TRUDI RASH
Dr. Rash welcomed the committee and guests to the second part of a three-part series of educational
workshops.
Summary approved
APPROVAL OF JUNE MEETING SUMMARY
UPCOMING MEETINGS (send agenda items to stephanie.woods@glms.org)
Aug. 16, 2012
Anthem IIRC
GLMS Offices
August 30, 2012
CGS IIRC
GLMS Offices
September 7, 2012
Passport IIRC
GLMS Offices
Sept 13, 2012
UHC IIRC Roundtable
GLMS Offices
Sept. 27, 2012
Humana IIRC
GLMS Offices
Dr. Rash reminded the committee to submit hassles/agenda items as soon as possible for the upcoming
GLMS/UHC Roundtable to be held on September 13, 2012 in order to allow the insurer ample time to
get responses to the issues.
NEW BUSINESS
Committee to
submit hassles and/or
agenda items for
UHC IIRC
Roundtable
on 9.13.12
Advocacy House calls
Stephanie reported that she made a house call to Internal Medicine & Pediatric Associates which was
very successful. Many issues were discussed and not all were about insurance. Stephanie reminded
the committee to call GLMS to set up a house call to discuss any issues, including those about PQRS,
Meaningful Use, etc.
Dr. Rash stated that GLMS will be holding a Small Practice Forum on July 18 at 7:30 am at their
location at 101 W. Chestnut Street. This meeting is in response to the June PPAC presentation on
Meaningful Use and it’s purpose will be to discuss issues and problems that small practices are having
complying to the new Medicare regulations and other concerns.
GLMS to hold Small
Practice Forum on
7.18.12 to discuss
Medicare regs and other
concerns
GLMS to hold
Dr. Rash reminded the committee that there will be a Town Hall Meeting on July 26 at 7 am at GLMS Town Hall on 7.26.12
with attorneys from Wyatt, Tarrant & Combs who will be talking about the implications and
regarding the controlled
substance law.
requirements of the controlled substance law.
COUNTDOWN TO ICD-10 - THE BUSINESS IMPACT OF ICD-10 – JESSICA WILLIAMS
Entire presentation can be
viewed on the GLMS
Website under Advocacy,
Up to this point, the “Countdown to ICD-10” series has given examples of how the number of codes
Physician Practice
will increase under ICD-10 and how greater specificity in documentation will be required for payment.
Advocacy and PPAC.
However, the transition to ICD-10 will also impact the business operations of the practice. Everyone
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who currently touches an ICD-9 code will be affected – front desk, nurses, physicians, clinical area,
managers, lab, billing and, of course, coding. Currently, a proposed rule has ICD-10 implementation
scheduled for October 2014.
By starting on planning, communication and awareness, and assessment now, practices can have a
smooth transition to ICD-10.
The Centers for Medicare and Medicaid Services has produced an ICD-10 implementation guide for
small and medium practices that contains helpful checklists and timelines:
(www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html)
There are numerous other ICD-10 resources available, many for free, that can be utilized.
Planning
9:57
The top leadership of the practice must understand the significance of the transition to ICD-10. This
should be clear to physicians, particularly those in smaller practices who realize how coding affects
the bottom line.
Transitioning to ICD-10 will be an involved process, and the practice manager should not try to handle
all aspects. He or she should establish a project management structure. Key staff members, perhaps a
lead coder, should be identified and empowered to develop education for staff, for example.
Practices will need to know when their external vendors are ICD-10-ready. If vendors are not
prepared, the practice’s preparation will be useless. All entities need to be ready ahead of the
compliance deadline so that practices can run end-to-end testing ahead of time.
For this planning process, creating a well-defined timeline and accountability for the practice will be
important. Coding is the currency of your practice.
Communication and Awareness
13:14
When it comes to communication, start making each staff member aware of what ICD-10 is and how it
will affect each person’s job duties. Keep the explanation simple and repeat it as necessary. The truth
is that everyone will need education. For coding staff members, perform a detailed assessment of their
current knowledge. Some may need additional education in the areas of anatomy and physiology to
prepare. Closer to the implementation date, each coder will need at least 20 hours of intense training.
To practice documentation under ICD-10, try selecting a high-volume code and using the ICD-10
codes now. Choose one code per month or one per quarter. This exercise will familiarize everyone
with the changes and make a difference later on. About three to six months before the implementation
date, physicians will need specialty-specific training on documentation.
Unfortunately, the transition to ICD-10 will have an impact on the practice’s budget, but the cost can
be spread over a few years. The implementation budget must include:








Hardware, software, EHR templates and maintenance fees
Communication (new forms, internal communications)
Training
Outsourcing or consultant fees
Temporary staffing needs
Data conversion
Report design and reprinting paper forms
Systems testing
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31:49
In addition, there will need to be a budget after the transition for monitoring code compliance, ongoing
education and revenue stream analysis. The practice must ensure that the new codes are being paid at
the correct rate. An initial loss of revenue is to be expected as coding takes longer, claims are
adjudicated more slowly and claims are rejected. The practice can prepare for cash flow delays by prepaying with vendors if possible, managing accounts receivable, collecting co-pays and deductibles at
the time of service and checking with the bank on an increased credit line, to be used if payers
experience problems with ICD-10.
Assessment
The practice should monitor the status of both vendors and payers on ICD-10 readiness. Healthcare
Information and Management Systems offers a “VitalVendor” readiness tool
(www.himss.org/ASP/topics_icd10playbook.asp) where major vendors are reporting their status. Ask
vendors these questions and track their answers in a spreadsheet:
 Will software be replaced or updated?
 Is a demo available?
 What is the timeline for go-live?
 Will there be a new service level agreement, contract or fees?
For payers, find out when testing will begin, how the referral/authorization will change and whether
contracts will change. GLMS plans to gather this information from payers through its five Insurance
Issues Resolution Committees.
GLMS to gather information
regarding:
Vendor ICD-10 testing dates
How referral/auths
will change, and
whether contracts will
change.
These steps can help make the transition to ICD-10 manageable for the practice. Now is the best time
to begin planning, communication and assessment – the keys to successful implementation.
ICD-10 Resources:
-
CMS ICD-10 Implementation Guide for Small and Medium Practices
o http://www.cms.gov/Medicare/Coding/ICD10/downloads/ICD10SmallandMediumP
ractices508.pdf
-
Enroll for CMS ICD-10 email updates
o https://www.cms.gov/Medicare/Coding/ICD10/CMS_ICD10_Industry_Email_Updates.html
-
AHIMA ICD-10-CM/PCS Readiness Assessment and Prioritization Tool
o http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_046262.pdf
-
ICD- 10 Form Letter and Vendor Questionnaire
o https://www.glms.org/Default.aspx?PageID=500
-
ICD-10 Vendor Readiness Tool – online self-reported readiness by vendors, courtesy of
HIMSS
o http://www.himss.org/ASP/topics_icd10playbook_vitalVendors.asp?faid=573&tid=
100
- AHRQ Article on the Impact of ICD-10 in Quality Reporting and Physician Monitoring
http://www.qualityindicators.ahrq.gov/Downloads/Resources/Publications/2011/ICD10%20Report%2002-08-11%20Final.pdf
NEXT MEETING: August 9, 2012, 7:00-9:00 am, Baptist Hospital East Auditorium – ICD-10
Documentation
ADJOURN
4
GLMS/PPAC Educational Series
The Business Impact of ICD-10
July 12, 2012
Physicians:
Trudi Rash, MD, Chair
Berberich, Susan MD
Dee, Michael MD
Martin, Alvin MD
ATTENDANCE
Practice Mgmt Representatives:
Beckman, Libby
Breedlove, Julie
Carlisle, Laura
Christian, Terri
Collier, Melissa
Dawling, Michelle
Esterle, Elaine
Gossman, Jan
Haworth, Sandy
Hilton, Demetria
Hyland, Jane
Kastanis, Terry
Kissell, Lynn
Kustes, Brenda
Leep, Bunny
Mattingly, Sherry
McCallister, Mary Pat
McGary, Annette
McGregor, Amy
Nave, Nona
Priddy, Sherry
Ray, R
Sacra, Patti
Thomas, Sherry
GLMS Staff:
Lelan Woodmansee, GLMS, Executive Director
Jessica Williams, GLMS Manager,
Physician Education and Practice Support
Stephanie Woods, GLMS Senior Advocacy
Specialist
Joyce Goldin, GLMS Administrative Assistant
Ellen Hale, GLMS Communications Associate
LMS Executive Committee:
Russ Williams, MD, President
David Bybee, MD, Board Chair
James P. Murphy, MD, Pres Elect
Robert Zaring, MD, Treasurer
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