Advance medical icd10 best practices

HOW A SMALL PRACTICE IS

MEETING ICD-10 READINESS WITH PRECISION

Lori’s Story

Lori Ann Martell, LPN, CMPE, Practice AdministratorAdvance Medical of Naples LLC

July 18, 2014Open Line Friday Provider ICD-10 Teleconference(www.floridablue.com/icd-10)

http://www.floridablue.com/icd-10

Lori’s Story:How One Small Practice is

Meeting ICD-10 Readiness with Precision

The following content represents the information delivered by Lori Ann Martell of Advance Medical of

Naples, LLC during the July 18, 2014 Open Line Friday ICD-10 provider teleconference. For more

information about Open Line Friday, visit www.floridablue.com/icd-10

http://www.floridablue.com/icd-10



Advance Medical of Naples, LLC

Physician practice of 10 full-time providers, 74 employees

Operates12 hours per day/7 days per week

Handles a fair amount of walk-in business specializing in: Primary Care Occupational Medicine

Commercial and regular commercial contracts

Workers Comp

How We Started ICD-10 Workgroup – Six employees representing the different practice

areas believed perceived to be most impacted by ICD-10 (medical director/owner, billing, nursing, IT, reception, office administrator) Met bi-weekly for 1-hour Medical director/owner challenged us with goal: Have less than 10% change

of income directly related to incorrect coding with ICD-10 implementation. Set timeline goals for go-live and bi-directional testing readiness Financial analysis

Analyzed the % of daily charges that were at risk for rejection Focused on the 47% of gross charges at risk due to standard commercial

contracting and determined this was what we’d conquer first



How We Started (continued) MGMA ICD-10 Implementation Guide - A great resource, purchased/used

for our governances and development of many of our policies and procedures

Addressed EHR readiness/ICD-10 integration needs – (Office Administrator and IT) attended user conference Studied diligently, learned what needed to be done Shared learnings with team and assigned roles & responsibilities Created implementation schedule with timeline

Updated latest version of software Trained staff on the layout for the system to become familiar with updates

and changes to our workflow



How We Started (continued)

Daily meetings: We added ICD-10 to our morning “huddle” meeting. As we discussed who the providers were for the day, patient demographics of the day, special issues, who’s handling what, etc., we began including progressively more updates on ICD-10 which included:

ICD-10 status updates – where we are, what’s coming next How would today change if we were in the ICD-10 world

Completed a skills analysis for staff - included areas of interest they had or desires for education/learning; identified staff willingness to assist and engage in education



ICD-10 Education (continued)

Lesson Learned:

Problem: Booking a patient for an incorrect chief complaint would lead the clinical staff to assume a certain template development which would take us half way through intake before realizing we were off course.

Solution: We looked at overall flow and identified areas causing issues and identified staff needing performance improvement. The practice paid in full to educate those requiring training (with the condition they’d receive a passing score and remain employed with the practice for two years). This empowered staff.



ICD-10 Education (continued) AAPC ICD-10 training - billing staff, front desk leads, IT, office administrator Basic Anatomy & Medical Terminology classes – front desk receptionist and

non-clinical licensed staff were included as a result of earlier analysis regarding operational deficiencies. Discovered this staff was technically skilled but lacked the knowledge to identify conditions.

Observed healthy competition from education – a level of competitiveness

existed among staff during learning activities With patient data, created case studies for staff to identify skills, strengths and

weaknesses in documentation, missing history, clinical data, etc.

Looked for missing information needed for our processes; remediated our

capability to accurately assess the patient, improve the quality of care and provide

the correct coding for billing and reimbursement.



Coding and Documentation

Examined documentation and diagnosis codes and considered how

this would look in ICD-10.

Identified the top 25 diagnosis codes for family practice, disease

management, illness and injury & lacerations. Reviewed current documentation and identified areas for improvement to

capture necessary data to support accurate coding

Focused on quantity – how many diagnosis codes did we have? We picked the

top 5 to address first (those posing largest financial impact on the practice). If

we could get these top five repetitive codes well documented, the history in prior

to 10, then at least we could rest assured this portion would be 100% accurate.



Coding and Documentation (continued)

Improved information capture/accuracy of documentation Front desk & phone operators learned medical terminology resulting in improved

accuracy in entering chief complaints

Altered EPM & EMR for front desk access – now they could cross into the clinical area;

accuracy of documentation now supported complexity of coding and diagnosis

User licensing costs increased; however, time management utilization and better use

of provider time may simply offset this cost.

Information templates – initiated detailed approach to gather information needed for

coding in ICD-10 by developing information templates – adding one new template per

month

Became more disciplined about incorporating clinical record back into our record so we

could see the disease process (realized this had been a missing link for our practice)



Coding and Documentation (continued)

Improved information capture/accuracy of documentation

(continued) Rebuilt patient questionnaires to capture more detail (historic data, specialist

appointments, more detail of family history) during intake

Revised injury-related intakes for more detail (mechanism of injury, etc.)

Lesson Learned: In any medical practice, staff gets busy and the detail, at times,

gets lost. We realized how incredibly important the correct details are for moving

forward with ICD-10 . Though it may seem arduous at first spending time getting the

extra detail and information needed, especially on illness and injury, consider the

rewards – less paperwork needed to submit, cleaner claims, and faster claim

turnaround time – if we share accurate information between entities. It is time we work

together and move forward.



Coding and Documentation (continued) Improved information capture/accuracy of documentation (continued)

Revised EMR for detailed nursing intakes (responsibility of nursing)

Information is downloaded electronically from patient iPad questionnaire

Deferred orders now seen by reception upon scheduling – If patient is due or past

due for any deferred, receptionist is now able to schedule and schedule the follow-

up appointment so we have the data capture at the time of visit.

Revised order entry stream to be specialized by disease management for ease of

access and a reminder of what's expected by disease process for accurate monitoring

and testing.

Developed dynamic templates w/free text to add amount of data needed for

mandatory information to be added when needed

Deploy one major template per month into clinical workflow, evaluate and finalize

for permanent use in practice.



Coding and Documentation (continued) Improved information capture/accuracy of documentation (continued)

Moved billers from clerical to clinical area and create two shifts with complete

staff to ensure things are done correctly, assisting the provider not to become

overwhelmed or completely dismayed, and teach nursing and medical staff what

information/documentation may be missing.

Changed how we check out patients

Redefined the check-out reception position – more focus placed on E&M code-

entry accuracy, charge capture and collection rate at time of service with the

understanding the correct coding will be in place by the time the patient makes it to

check out. This allows us to have fairly clean documentation, a fairly clean claim

and a little bit less scrub on the back end.

Cross-trained front desk check-out staff for basic billing tasks, assisting in AR

and offset some of the loss of the billing staff we had as we transferred them into

clinical area.



Next Steps

Continue moving forward for the Oct 1, 2015 go-live

Preparing – break into small components

Maintaining – revisit learnings, maintain changes, stay current with industry

news and communications

Testing – engage in testing of ICD-10



Things to consider moving forward…

“It’s an awful thing – in the middle of your busy day to sit down and think, OMG, this

(lack of ICD-10 readiness) could put us out of practice. In this light, you realize that

you do not have any choice but to address it and continue the march forward.”

“Breaking it down into little components is key. From a clinical and clerical

component, you can’t overwhelm your staff if you think you can flip a switch closer to

the compliance date. It’s simply too overwhelming. The bottom line is you have to

keep your appointments coming in the door, you have to manage these patients and

you have to get your claims out the door. I do not know of any other way to be

prepared to continue running your practice than to slowly phase the change in with

small steps”.

We have a lot of work left to do!



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Advance medical icd10 best practices