Here we go—this is the year of change: The Affordable Care Act implementation has started; Medicare’s flawed Sustainable Growth Rate formula for its physician fee schedule is finally being fixed; and the ICD-10 rolls out in October. Add to that: changes in professional responsibilities tied to Meaningful Use Stage 1 and Stage 2 EHR Incentive Programs; increased scrutiny of professional services via prepayment audits (meaning your practice is targeted for review prior to getting paid)—and many of us are just now implementing many of the new rules that were put into place last year.
Holy $#@%! What’s a health care provider to do?
Plan for Change
First of all, don’t panic. All of these changes are manageable. But, you have to have a plan to track, prioritize, integrate and implement these changes into your practice.
Let’s use the ICD-10 as an example.
The implementation date is October 1. So, knowing that you have about nine months to go, what does your roadmap for implementation look like? CMS has published a number of training schedules and checklists that you can reference (www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html). Keep in mind that eye care providers have a very focused implementation of the ICD-10, so not everything on the CMS list applies to you.
Here’s how you could approach it.
1. Obtain the new CMS-1500 forms (if you still print out a paper form for submission) and/or start a dialogue with both your EHR provider and billing gateway to ensure that they are using the new format, which was required as of January 1, 2014.
2. Talk with your EHR provider to find out how it’s rolling out its transition from ICD-9 to ICD-10. (Keep in mind that you’ll need both code sets to run simultaneously for one full year: October 1, 2014 to September 30, 2015).
3. Check with your billing clearinghouse to find out how it’s implementing its transition from ICD-9 to ICD-10. How will it track claim rejections, reprocess claims that have dates of service prior to the October 1 start date, etc.?
4. Mine your EHR database for your top 25 diagnoses that were billed in 2013, based upon frequency.
5. Categorize these diagnoses. For example, refractive/contact lens related diagnoses vs. medical diagnoses. And further subdivide these into anterior segment (allergy, infectious, inflammatory) vs. posterior segment (glaucoma, macular degeneration, retinal vascular disease), and so on.
6. Get current information. Access resources (such as
www.icd10data.com/Convert) to assist you with the crosswalks from the ICD-9 to the ICD-10.
7. Hold monthly training sessions with your entire staff to work on a specific group of diagnoses. For example, learn the refractive changes in February, anterior segment (infectious) in March, anterior segment (allergic/inflammatory) in April, and so on. By the end of summer, everyone in the office will be well versed in the ICD-10 format of the diagnoses that you work with 95% of the time.
8. Confirm with insurers that their claims processing will not be delayed with ICD-10 submissions.
9. Have your entire office staff attend CE sessions on ICD-10.
While this is just an illustration of how to manage a change event in the practice—from discovery to integration—the concept can be applied to any of the arising issues. The key is to assign a single source within the practice who will track and disseminate information about changes that could impact the practice. Create opportunities for training, and commit yourself to following through to successful implementation.
Keep in mind that change isn’t always bad. It’s how you approach it and manage it that makes the difference. So, learn how to anticipate change, embrace change, direct change and enjoy the benefits of what successfully integrating change can bring. Maybe 2014 isn’t just The Year of Change—maybe it’s also The Year of Success!
* Disclaimer: As the owner of this company, I have a financial interest in this product.