With the HIPAA 5010 conversion drawing to a close and the ICD-10 transition in flux, it may seem like physician practices are spending considerable time and effort preparing for, engaging in, and responding to large-scale system upgrades. These kinds of multi-faceted implementations can be daunting, particularly if a practice tries to address their many parts simultaneously.
A better approach to navigating any sizable implementation is to embrace a methodical, step-by-step process that keeps the big picture in mind. As many organizations learned, this was the key to a successful transition to 5010, especially for clearinghouses or other technology partners whose clients relied on a swift and easy transition. Throughout this most recent transition and others, a few specific strategies have proven to be especially important:
- Start early. This is essential to keeping a potentially unruly implementation effort in check. Most of those who transitioned smoothly to 5010 started preparing for it years in advance. The deadline for ICD-10 is not until Oct. 1, 2013 (and will likely be pushed back further from that date); however, practices that start preparing for this implementation now will have an easier time meeting the deadline. Breaking a project into multiple, manageable steps and setting deadlines for each step can ensure your practice stays on track.
- Understand the requirements and scope of the project. Spending time understanding the many nuances of a large-scale implementation like ICD-10 is valuable because it allows you to get a sense early on for how the transition will impact your practice and what you will need to do internally to achieve success. This exercise will also help your practice realize what it needs from vendors and payers.
- Put together a team. Creating a team to spearhead your practice's implementation efforts is important because this group will quantify the scope of the endeavor; conduct a gap analysis; communicate with vendors; focus training; and navigate the intricacies of the transition. For ICD-10, the team should include a balance of financial, administrative and clinical leaders as well as front-line staff who actually do the work affected by the new code set. For example, individuals who verify eligibility, file claims and code medical documentation are essential so the team can truly grasp what's involved in these activities and how they will be impacted.
- Conduct a gap analysis. This detailed review should focus on how the systems in your practice will be affected by a multi-faceted implementation. It allows a practice to specifically pinpoint areas that need to be upgraded, and determine what those upgrades will entail. Such an analysis can also help prioritize work and support more accurate timelines.
- Reach out to vendors. For many projects, such as 5010 and ICD-10, practices must rely on their IT vendors to make changes to affected systems. As your practice begins a new initiative, you should communicate with your technology vendors to gain an understanding of their timelines, processes and plans regarding the new initiative and how their current or planned services or features may assist your practice. For example, with ICD-10, vendors should not only be showing an awareness of the new code set and the deadlines associated with it, but also communicating a real commitment to developing solutions that help your practice meet the deadline.
- Plan for education. With any new system or changes to business processes or medical reimbursement policy, education is paramount. All staff impacted by these changes should receive training to ensure the practice achieves all clinical and business objectives. Sometimes this training will be complex, so your practice must decide early on in the preparation process how it will provide education. For example, with ICD-10, both the practices’ administrative and clinical staffs will be impacted -- including physicians, who will, at a minimum, need to understand how medical policy and clinical documentation will change and, perhaps, even how to code using the new code set. Putting together a training plan for physicians is essential to a successful transition. Those ICD-9 codes that have been expanded dramatically in ICD-10 offer a good place to begin training, for instance. Also, focusing on your practice's top diagnosis codes in terms of revenue and volume can be beneficial. Technology vendors and solutions that can help you pinpoint frequently used ICD-9 codes can be valuable partners in identifying possible areas for training.
For sizable projects such as 5010 or ICD-10, the key to success is getting started early. Putting off the work can cause severe financial ramifications down the road. By creating a team to drive the effort, determining your practice's unique needs, communicating with vendors, and putting a plan in place for training, you can make sure your practice is ready to efficiently and effectively navigate any large-scale endeavor.
Ken Bradley is the vice president of strategic planning at Navicure, a medical claims clearinghouse. For more information about the 5010 and ICD-10 implementations, including detailed preparation timelines and more, visit www.icd10hub.com.