#physician advisor

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What We Can Learn from the ICD-10 Implementation in Canada

Canada’simplementation of ICD-10 documentation offers U.S. hospital administrators a number of important lessons. The Canadian single-payer system started the implementation of the ICD-10 coding implementation, among various provinces, in stages from 2001 to 2004. As hospital administrators work toward ICD-10 coding compliance, the following offer vital lessons:

1. Adequate Planning and Preparation are Essential

Administrators must take time to plan the implementation of the transition from ICD-9 to ICD-10 coding. The medical authorities in Canada initially underestimated the volume of work needed for full implementation of ICD-10. Hence, budgets and timelines were seriously underestimated because of unavoidable delays and many unknown variables that were not even anticipated at the beginning. For instance, when Canada rolled out its ICD-10 system, the Windows-based software for coding was just making its debut. Coders had to grapple with the new code set as well as the challenge of switching from manual recording to the use of Windows-based desktop software. This led to so much inefficiency because the initial magnitude of process changes was underestimated. 

2. Physicians Need to Be Involved Early

U.S. physicians must understand the scope of the ICD-10 coding from the onset. This may be achieved through comprehensive physician documentation training. Adequate training will enable them to select the systems and tools that best work for them. Physicians also need to build up their documentation skills early so that medical coders can assign codes accurately. Such training should even start in medical school. Unfortunately, many medical schools have not realized the importance of this type of training and dedicate only a few hours to detailed physician documentation training. Better training will enhance the productivity of the coders and the overall medical reporting system. 

3. Anticipate Budget Overruns and Project Extensions

From the Canadian experience, and with the complete paradigm shift involved in moving from ICD-9 manual coding to the computerized and complex ICD-10 coding system, every hospital administrator should expect delays in project completion time. And the transition will cost more than expected—by at least 25 percent more. Since you will experience delays, it means the best time to start planning and training for your ICD-10 project is now. 

4. Understand the Nature of the ICD-10 Learning Curve

More training is required for coders if they are going to achieve anything close to 70 percent productivity within the first year of implementation of the ICD-10 coding system. In Canada, the coders that were able to excel had to take extra responsibility for their professional development. The initial mandatory training was not adequate. Medical coders need to be able to use mobile educational solutions and specialized tools in their spare time to learn the coding faster and better contribute to their organizations. 

To begin preparations for the successful implementation of this medical coding system in your healthcare facility, consult an ICD-10 project implementation and training firm. 

Provident Consulting

30600 Northwestern Highway, Suite 305 Farmington Hills, MI 48334-3172 [email protected] [phone]  http://www.providentedge.com

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Understanding ICD-10

The ICD-10 is the 10th revision of disease classification authorized for publication by the World Health Organization. The ICD coding system was created for mortality coding and classification of death certificates, and although ICD-9 is currently being used in the classification of disease and injuries in clinical settings in the U.S., the transition to the new system has been ordered and every entity in the medical field to be affected.

Why ICD-10?

There are various reasons why a transition to a newer coding system is in order. ICD-9 has been the cornerstone of morbidity and mortality coding for 30 years and areas for improvement have been identified. The older system is no longer robust enough to serve the health and medical needs of the modern-day healthcare system. Clinical content is far from accurate, and there is limited data about medical conditions and procedures. ICD-9 also has a insufficient number of codes, and experts admit that the coding structure of the older system is too restrictive.

A move toward ICD-10 is particularly crucial in the U.S., where coding for mortality data is not on par with the rest of the world.ICD-10 is an improved system that is designed to enhance the quality of data for tracking public health conditions, provide data for improved medical research, allow for more accurate clinical decisions, and make fraud and abuse easier to detect.

What provider changes can you expect?

Providers face a lot of work in order to comply with the requirements of the new code. They can expect a reduction in productivity as entire hospitals and clinics try to cope with the changes. There may also be accompanying risks of denials as part of the growing pains that come with getting used to a new coding system.

Providers can expect to make changes in the areas of analysis programs, data extraction programs, how they use data tables, and reporting. Familiarity with new matrices, table formats, and new terminologies will be required and can be accomplished by training all staff and personnel that handle patient data. Training and Transition Tips With the switch to a newer code comes the need for additional education and training on data management and clinical documentation. Hospitals and practices must educate physicians and staff on how to work with the new set of codes. Physician employers and hospital administrators can work with hospital administration consulting firms who can help them formulate training programs and timelines that will get them ready for the transition in time.

Important steps include the development of a project plan, setting up a managing team to lead the entire hospital or the clinic through the process of transition by implementing the plan, assessment of training and education needs to ensure that resources are utilized in the most efficient way possible, and conducting post-implementation follow-ups to ensure that all systems are working seamlessly with the new code.

Contact Provident Consulting to make sure you're ready for the 2015 ICD-10 transition.   

Provident Consulting 30600 Northwestern Highway, Suite 305 Farmington Hills, MI 48334-3172 [email protected] [phone]  http://www.providentedge.com

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Understanding The Impact Of ICD-10 Diagnosis Codes

Physicians, Nurses and Other Healthcare Providers Physicians and other healthcare providers are directly affected by the switch because they and their staff will need to learn about changes in ICD-10 and the added codes that will be used to code a diagnosis. Doctors, nurses, and staff will need to update their knowledge of these codes, particularly those that they use most often. This helps ensure the accuracy of claims and that the right claims go to the right payers.

Health Insurance Providers Health insurance companies, including Medicaid and Medicare, are considered the payers. They are affected because they need to reevaluate the standards for medical necessity. These companies must take steps to make sure that the transition from ICD-9 to ICD-10 goes smoothly and to prevent problems such as double-billing, which could happen when a billing includes both ICD-9 and ICD-10 codes.

Clearinghouses These are the middlemen that connect physicians with paers. They sort and organize claims, a task done by a coding and administrative staff that must be acquainted with the new set of medical diagnosis codes.

Knowing who will be affected is crucial in order for affected agencies to prepare and have a clear list of expectations when the switch to ICD-10 occurs. For example, experts tell doctors with orthopedic practices to expect a decrease in productivity when they switch. There is a need, therefore, for in-depth education and training in order to facilitate a smooth transition from the old to the new code. Clinical documentation education of hospital administration personnel which is best provided by hospital administration consulting firms is crucial to reduce the negative effects of the switch such as delays in claims processing and increase in the number of rejected claims because of inaccuracy or ambiguity.

Contact Provident Consulting to prepare for the implementation of ICD-10.

Provident Consulting 30600 Northwestern Highway, Suite 305 Farmington Hills, MI 48334-3172 [email protected] [phone]  http://www.providentedge.com

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Importance Of Denial Claims Management in Healthcare

Contact Provident Consulting to get your denials managers in place before October 2015.

Provident Consulting 30600 Northwestern Highway, Suite 305 Farmington Hills, MI 48334-3172 [email protected] [phone]  http://www.providentedge.com

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How a Physician Advisor Improves Hospital Operations

A physician advisor also serves as the intermediary between hospital staff and the team tasked with clinical documentation. The advisor:

educates medical staff on importance of compliance with hospital regulations

educates staff on ICD-10 documentation requirements

conducts documentation training to physicians

educates medical staff on changes in coding methods

educates medical staff on changes in specific hospital policies

conducts individual physician advisory and education

assists staff in preparing documentation for Medicare compliance audit

assists in the drafting of appeals in case of RAC (Recovery Audit Contractor) denials

assists in the development of standardized queries

As part of his responsibility as a member of the team, the physician advisor may be required make rounds both with doctors and with multidisciplinary management teams to ensure quality of care, compliance with hospital procedures and policies, and proper communication among staff members. The physician advisor may also play the role of mediator when conflicts between departments, teams, or individual staff members arise. 

Why Hospital Case Managers Need the Expertise of Physician Advisors Physician advisors play a crucial role in hospital administration because they bridge the gap between case managers and the people who implement hospital procedures and policies. For one, they assist nursing staff in the enforcement of medical decisions in a timely manner to ensure quality patient care. They also collaborate with physicians on patient issues that have been identified by case managers, eliminating the need for case managers to deal with physicians on an individual basis. In most cases, physician advisors hold a certain degree of influence over their peers, since most of them are physicians themselves. This helps them ensure that decisions are firmly implemented. Physician advisors know how to balance collegiality and firmness and often enjoy the respect of hospital staff due to years of clinical expertise and good interpersonal skills. Having a physician advisor therefore ensures better communication between departments and individual staff members as well as ensure the proper flow and implementation of policies by the teams that are in charge of their implementation. Contact Provident Consulting to find out how a physician advisor can add value to your healthcare organization.

Provident Consulting 30600 Northwestern Highway, Suite 305 Farmington Hills, MI 48334-3172 [email protected] [phone]  http://www.providentedge.com/