ICD-10 and meaningful use present significant changes and challenges for orthopedic practices, and a panel of physicians at the American Academy of Orthopaedic Surgeons Annual Meeting 2013 tackled several steps toward preparedness. In a session titled "Getting Ready for ICD-10 and Meaningful Use Stage 2," William Beach, MD, Louis McIntyre, MD, and Ranjan Sachdev, MD, presented on the main areas practices should focus on to properly implement the code set and regulatory milestones. Jack Mert, MD, moderated the session.
How ICD-10 Works
The updated international classification of diseases code set will take effect Oct. 1, 2014, and the structure requires physicians and coders to gather and document more data on patients to justify codes submitted for claims, Dr. McIntyre said.
He then broke down the structure of an ICD-10 code, which contains seven characters rather than ICD-9's maximum of five. The characters spell out what chapter of the code book the disease is categorized under, the details of the disease or condition, the side/site/severity of the disease and whether it was the patient's first physician visit or a subsequent visit. Fractures will become more complicated to code because physicians have five classifications rather than just open or closed, he said.
"It behooves [physicians] to learn the system so we can pass clean code along to our coders," Dr. McIntyre said.
While staff members will be able to find all codes using the ICD-10 manual, the process is time consuming and would dramatically reduce productivity. Instead, electronic systems can speed up the process. AAOS is in the process of developing its Codex-13 online program to assist coders in quickly assigning correct codes. The program features a pick list and key word search. "If you know all you need to plug in, you can get the code easily," he said.
CMS estimates the transitional costs of ICD-10 could range from $83,000 for a medium-sized practice to $2.7 million for a large practice. The American Medical Association recommends practices take the following steps to prepare:
• Organize the effort
• Analyze the impact
• Contact vendors
• Budget for costs
• Implement software and systems upgrades
• Conduct internal testing
• Train staff
• Conduct external testing of transactions
The entire process could take up to 22 months, and only 18 months remain before the deadline.
Financial and Operational Impacts of ICD-10
Dr. Beach discussed the various impacts of ICD-10, and particularly stressed the need to be increasingly aware of fraudulent activities, such as upcoding or incorrectly coding. He called on orthopedic surgeons to take the lead in getting staff members on board with the code set changes.
"Physicians have to be the champions of this change," he said. "We can't expect people in our organizations to be compliant and excited if we don't lead the charge."
Leadership must understand the breadth and significance of the ICD-10 change, he said. While training staff members, recognize accomplishments and reward people who do a commendable job with their ICD-10 education. Rewards and goals will encourage people to learn the new codes.
Though he believes financial estimates are higher than what most practices will actually spend, the implementation process will still be expensive. Practices must look at every phase of operation and note which processes will require more documents, revised forms or changes in software. He also recommends getting certified coders to ensure claims are completed properly.
Payor readiness may be problematic. Practices should expect for delays in payments and have extra cash on hand to cope with slower reimbursements. Practices will also need to evaluate their vendors.
"The biggest internal key is to set up training," Dr. Beach said. "Test nurses and people that work for you. Understand the change and the potential liabilities if we don't do it correctly."
The ICD-10 switch comes at a busy time for healthcare reform, where recovery audit contractors are more fervently seeking violators. Dr. Beach called it the "perfect storm" of decreased reimbursements, more audits, increased coding requirements and limited time for physician education and focus.
Though the transition may be challenging and intimidating, physicians can fight back, he said. Get educated, get focused and make coding and reimbursement a priority. "Rekindle the 'intern' in you," he said. "Regain your intellectual curiosity and professional competitiveness."
Meaningful Use State 2
Practices should have already implemented Stage 1 of Meaningful Use. While Stage 2, which goes into effect in 2014, builds upon the first phase, it also includes many new requirements, Dr. Sachdev said. Providers must still have a certified electronic health record for attestation to qualify. Stage 2 includes 16 core measures and three of six menu items. Many menu items from Stage 1 moved to core items and new menu items have been added, he said.
One increased measure is for incorporating lab results as structured data. For Stage 1, 40 percent was required, and 55 percent will be required for Stage 2. For one new measure for Stage 2, 5 percent of patients must be sent a secure message using messaging function of certified EHR technology. Other new measures include recording electronic notes in patient records, recording family health history as structured data, having imaging results accessible through the EHR and having the capability to identify and report cancer cases to the state cancer registry.
Providers should be aware of compliance risks with Stage 2, including the significant risks of inaccurate attestation. Physicians can also expect more audits and checks, as well as greater fines and penalties under the False Claims Act.
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How ICD-10 Works
The updated international classification of diseases code set will take effect Oct. 1, 2014, and the structure requires physicians and coders to gather and document more data on patients to justify codes submitted for claims, Dr. McIntyre said.
He then broke down the structure of an ICD-10 code, which contains seven characters rather than ICD-9's maximum of five. The characters spell out what chapter of the code book the disease is categorized under, the details of the disease or condition, the side/site/severity of the disease and whether it was the patient's first physician visit or a subsequent visit. Fractures will become more complicated to code because physicians have five classifications rather than just open or closed, he said.
"It behooves [physicians] to learn the system so we can pass clean code along to our coders," Dr. McIntyre said.
While staff members will be able to find all codes using the ICD-10 manual, the process is time consuming and would dramatically reduce productivity. Instead, electronic systems can speed up the process. AAOS is in the process of developing its Codex-13 online program to assist coders in quickly assigning correct codes. The program features a pick list and key word search. "If you know all you need to plug in, you can get the code easily," he said.
CMS estimates the transitional costs of ICD-10 could range from $83,000 for a medium-sized practice to $2.7 million for a large practice. The American Medical Association recommends practices take the following steps to prepare:
• Organize the effort
• Analyze the impact
• Contact vendors
• Budget for costs
• Implement software and systems upgrades
• Conduct internal testing
• Train staff
• Conduct external testing of transactions
The entire process could take up to 22 months, and only 18 months remain before the deadline.
Financial and Operational Impacts of ICD-10
Dr. Beach discussed the various impacts of ICD-10, and particularly stressed the need to be increasingly aware of fraudulent activities, such as upcoding or incorrectly coding. He called on orthopedic surgeons to take the lead in getting staff members on board with the code set changes.
"Physicians have to be the champions of this change," he said. "We can't expect people in our organizations to be compliant and excited if we don't lead the charge."
Leadership must understand the breadth and significance of the ICD-10 change, he said. While training staff members, recognize accomplishments and reward people who do a commendable job with their ICD-10 education. Rewards and goals will encourage people to learn the new codes.
Though he believes financial estimates are higher than what most practices will actually spend, the implementation process will still be expensive. Practices must look at every phase of operation and note which processes will require more documents, revised forms or changes in software. He also recommends getting certified coders to ensure claims are completed properly.
Payor readiness may be problematic. Practices should expect for delays in payments and have extra cash on hand to cope with slower reimbursements. Practices will also need to evaluate their vendors.
"The biggest internal key is to set up training," Dr. Beach said. "Test nurses and people that work for you. Understand the change and the potential liabilities if we don't do it correctly."
The ICD-10 switch comes at a busy time for healthcare reform, where recovery audit contractors are more fervently seeking violators. Dr. Beach called it the "perfect storm" of decreased reimbursements, more audits, increased coding requirements and limited time for physician education and focus.
Though the transition may be challenging and intimidating, physicians can fight back, he said. Get educated, get focused and make coding and reimbursement a priority. "Rekindle the 'intern' in you," he said. "Regain your intellectual curiosity and professional competitiveness."
Meaningful Use State 2
Practices should have already implemented Stage 1 of Meaningful Use. While Stage 2, which goes into effect in 2014, builds upon the first phase, it also includes many new requirements, Dr. Sachdev said. Providers must still have a certified electronic health record for attestation to qualify. Stage 2 includes 16 core measures and three of six menu items. Many menu items from Stage 1 moved to core items and new menu items have been added, he said.
One increased measure is for incorporating lab results as structured data. For Stage 1, 40 percent was required, and 55 percent will be required for Stage 2. For one new measure for Stage 2, 5 percent of patients must be sent a secure message using messaging function of certified EHR technology. Other new measures include recording electronic notes in patient records, recording family health history as structured data, having imaging results accessible through the EHR and having the capability to identify and report cancer cases to the state cancer registry.
Providers should be aware of compliance risks with Stage 2, including the significant risks of inaccurate attestation. Physicians can also expect more audits and checks, as well as greater fines and penalties under the False Claims Act.
More Articles on Improving Profits:
ONP Specialty Group Opens Atlanta Orthopedics Division
5 Points on the Economic Impact of Orthopedic Surgery
5 Healthcare Trends for Orthopedic Surgeons to Watch