Change? It is the norm!

 

By: Richard Stroud, MBA FACMPE

UAB Eye Care

I read the blog on March 4^th that my colleague, Bill Cockrell, posted about how things have changed in his thirty-two years in healthcare management.  His second paragraph discusses all of the current issues that we all have to acknowledge.  The question that he posed “Is it all bad?” is dependent on where you are in your career journey.  My answer is no, because the constant will always be change.

In my experience, there have always been “issues” that have occurred every year.  Some of these “issues” crossed over to everyone that uses technology, not just healthcare (remember Y2K?).  And then, you have the “issues” that are fairly specific to health care, like HIPAA.  There are always discussions on other “issues” as well, like pay for performance – which is not unique to healthcare.

I recently attended the Alabama MGMA winter conference, which consistently puts together an informative program for physician practice managers.  It was well attended, but I also noticed that many of the attendees I had seen in the past were not there.  I am sure there were various reasons some did not attend (personal, financial, etc.), but I also know that at any given time – less than half of the medical practices in the state attend these meetings.  Why?

During this meeting, I heard a presentation on interacting with others – always a help for me, as I am somewhat dictatorial!  I heard a presentation on independent practices –something that has been on the forefront for a few months – with medical practices being sold (or leased or managed) to hospitals.  There were also presentations on various other topics – legal, accounting, collections, compliance – and all of the changes that are in effect this year.

But, I also was involved in several discussions about the routine stuff, like the “prima donna” employee that does not realize how dispensable she really is (and yes, there are doctors that can be lumped into that category).How about updated job descriptions that reflect what is truly going on in the office.  How about office hours – the pros and cons of early and late hours?  Insurance company problems – procedures not being paid (or paid correctly)?  Credentialing issues – who, how, when? Updating technology – is “the cloud” the way to go?

While I have not been in physician practice management for thirty-two years – I have been around for about nineteen.  I am not an expert in everything involved in the efficient performance of a medical practice!  I don’t think I have met that expert, or even heard of that expert.  But, I do know how to find the answers.  A majority of the questions that come up on a routine basis are not anything new, and many of my peers have already answered the question.  So why reinvent the wheel? 

Attending a state (or national) meeting is usually beneficial if you look only at the presentation content.  The real benefit is the opportunity to network with other professionals that can assist with the change and the day-to-day stuff.  Being able to identify those “experts” in each area – accounting, legal, technology, etc. – can save a lot of time (and money) when your practice is in need.  It is also reassuring to learn that those nagging problems that you have in your office are not unique, but everyone has them from time to time.  So, how do you handle the employee that thinks she is indispensable?  I have three different answers – and two of them she will not like!

In discussing memberships in various state associations, it is apparent that less than half will take advantage of this opportunity.  Cary Kuhlman, Executive Director of the Medical Association of the State of Alabama (MASA) said there were over 11,100 licensed physicians in Alabama, but only about 6,800 are members of the medical association.  Lisa Beard, Executive Director at MGMA-Alabama, said that the membership represents approximately 500 medical practices.  Knowing that many are members but do not participate, along with those that are not even members, what do they do for information?  I probably know the answer to that question, but that is another story – and I would not want to be involved with those practices!

Child Safety

By Bill King, Dr.P.H.

The Regional Poison Control Center at Children’s of Alabama handles more than 32,000 telephone calls every year concerning toxic exposures from household products, drugs, and even biologic and environmental hazards. Undoubtedly, the center is a well-known and well-used resource for medical doctors, veterinarians, other health care providers and the general public.

But many people are unaware that the Regional Poison Control Center is also just one of several related departments dedicated to the health and safety of children. All of these programs operate within the division known as the Southeast Child Safety Institute. This division provides research, education and community services to prevent childhood injuries.  Its programs also provide support to other professionals and agencies statewide who are advocates for the health and safety of children.

Here is a rundown of the Institute’s departments, what they do, and the managers to contact for more information:

Pediatric Health Information Line (Telephone Triage): This after hours, triage service provides a central point of contact for parents needing help in dealing with an ailing child. It contracts with over 300 practicing pediatricians throughout the state, the Jefferson County Health Department and other medical referral sources. Operating around the clock, seven days a week, it served nearly 90,000 callers last year. Tanya Crews and Jerri Phillips are co-supervisors. For information, call 205-638-6337.

Children’s Connection Line: This referral and consultation service connects families to pediatricians, specialists, car seat installation appointments and other vital services. It handled nearly 2,500 calls last year, and provided more than 1,000 consultations on child passenger safety, including car seat help for special needs children. Lisa Hanvey is the nurse manager. For information, call 205-638-6917.

Alabama Safe Kids: This educational service focuses on preventing unintentional injury to children. It focuses largely on motor vehicle safety, but it also works to prevent falls, poisonings, drowning, burns and choking. Alabama Safe Kids conducts car seat check-up clinics and child passenger safety certification courses for fire, police and other agencies. For example, last year, the program conducted 33 clinics at Children’s for checking car seats, and installed 921 of these crucial safety devices throughout the state. It offers educational programs on child safety and teen driving. Marie Crew is the state coordinator. For information, call 205-638-6339.

Kohl’s ThinkFirst Alabama: This comprehensive injury prevention program helps children develop safety habits that minimize their risk for brain, spinal cord and other traumatic injuries. It provides programs for elementary, middle and high school ages and provides an introduction to brain and spinal cord anatomy along with safety education for vehicles, water activities, bicycles, sports, weapons and recreation. Each year, the program strives to reach 10,000 children through statewide school presentations. Last year, it also provided concussion evaluation education to 77 coaches, trainers and program assistants. It also supported the Teen Driving Summit and fitted 350 bike helmets. Julie Cole Farmer is the state coordinator. For information, call 205-638-2729.

Regional Poison Control Center: This information hotline is one of the few services at Children’s that deals with adults as well as children. Last year, the center handled 32,545 calls, and provided more than 75,000 follow-up calls to assure appropriate treatment and outcomes. The center is supported by Children’s of Alabama and a long standing partnership with Blue Cross and Blue Shield of Alabama’s Caring Foundation.  Ann Slattery is clinical supervisor for the center. For information, call 205-638-9201.

In addition, the Child Safety Institute distributes a variety of printed materials, including booster seat brochures, car seat brochures in English and Spanish, injury prevention handbooks, poison prevention materials and bicycle safety brochures. Our Alabama Safe Kids program sponsored the re-printing of recent American Academy of Pediatrics car seat guidelines, which are distributed statewide to numerous agencies, law enforcement and pediatricians. More than 90,000 pieces of educational material were distributed last year through the institute.


Bill King is a pharmacist, clinical toxicologist and epidemiologist. He holds a doctorate in public health from UAB, and serves as director of the Regional Poison Control Center and divisional director of the Southeast Child Safety Institute at Children's of Alabama. He is a Professor of Pediatrics, UAB School of Medicine and also serves as adjunct faculty in Epidemiology (UAB School of Public Health) and Pharmacy (McWhorter School of Pharmacy). His research interests include the descriptive and clinical epidemiology and prevention of childhood injuries. For more information, call 205-638-6334.

Complying with Health Care Law’s Employer Mandate

By: Andy Andrews with Sirote & Permutt, PC

In the Fall 2012 edition of The Counselor, we examined the impact of the U.S. Supreme Court decision that upheld the Patient Protection and Affordable Care Act (ACA).  This article provides guidance to employers on how to plan for the “employer mandate” in January 2014.

 

The ACA introduces two new requirements that work in tandem to encourage expansion of health insurance coverage by individuals and employers.  The first requirement is the “individual mandate,” whereby most individuals must maintain qualifying insurance or otherwise pay an additional tax.  Health insurance exchanges will be established to facilitate expansion of the insurance market to individuals and small businesses.  The second requirement is the “employer mandate,” which generally provides that employers with more than 50 full-time employees must offer a minimum health care plan to their employees, or face one of two alternative required payments to the federal government.

 

As a business owner, what must I do now?  Employers need to consider how to address the employer mandate, decide on a plan, and begin to implement the plan now so that it will be in place once the employer mandate takes effect on January 1, 2014.  Below is a brief overview of 1) the basics of the employer mandate, 2) the payments employers may face and 3) employer considerations for addressing the mandate.

 

The basics of the employer mandate

The employer mandate includes two alternate payment provisions for employers known as “shared responsibility” payments.  They are often referred to as the “pay or play” penalty and the “pay and play” penalty.  To avoid these payments, applicable large employers must offer qualifying health insurance to substantially all of their full-time employees, the employee’s share of the insurance premiums must be affordable and the insurance offered must provide minimum value.

 

Applicable large employers.  Whether the employer is considered an “applicable large employer,” and therefore subject to the employer mandate payments, is determined by whether the employer employed an average of at least 50 full-time employees on business days during the preceding calendar year.  “Applicable large employers” are obligated to offer affordable insurance coverage that provides minimum value to full-time employees.  For 2014, employers may choose at least six consecutive months during the 2013 calendar year to determine whether they are applicable large employers.  There are special rules for “seasonal” employees.

 

Offer. The employer mandate does not require employers to ensure that all employees have health insurance, but that employers must offer insurance that meets the “affordability” and “minimum value” requirements to full-time employees.  Employers must make insurance available to employees and the employee’s dependents which includes the employee’s children.

 

Substantially all.  The Treasury Department recently proposed a rule that for applicable large employers to meet their ACA obligations, the employer must offer coverage to “substantially all” of their full-time employees—meaning 95% or more of full-time employees.  This proposal is not intended to exclude employees, but to forgive minor oversights.

 

Full-time employee. Under the ACA, full-time employees are those who average at least 30 hours of service per week.  Part-time employees’ hours count toward determining an employer’s status as an applicable large employer.  Hours from part-time employees add up to count as “Full-Time Equivalents” (FTE).  The FTE hours do not for calculating an employer mandate payment.

 

Affordable. For 2014, a plan is considered “affordable” when the employee’s required contribution for self-only coverage does not exceed 9.5% of the employee’s household income.  Some have argued that a plan could still be considered “affordable” where the required contribution for family coverage exceeds the 9.5% threshold.  The definition of “affordable” may be modified in the future, but for now it is based on the price of single coverage under an employer-sponsored plan.  Due to the difficulty of obtaining household income information, there are three “safe harbor” tests based on the employee’s wages that an employer may use to determine whether a plan is affordable.

 

Minimum value.  To meet the minimum value test, the health plan’s share of total allowed costs of benefits that are provided by the plan must amount to at least 60% of those total costs.  Essentially, this is an actuarial determination of the future benefits provided under a plan.  The determination is made on how much of the plan’s projected costs will be paid for by the plan.  The IRS and Department of Health and Human Services have proposed using a minimum value calculator whereby the components of a health plan can be plugged in to the calculator which will determine the “metal level” of the plan – whether bronze, silver, gold or platinum.

 

Employer mandate “shared responsibility” payments

If applicable large employers do not offer qualifying health insurance to substantially all full-time employees, which is affordable and provides minimum value, the employer will be subject to one of two payments.  Each payment is triggered by an employee obtaining a credit through a health Exchange.  Currently the proposed method of payment is that payments will be assessed on a monthly basis, but will be paid after the end of the year through a separate process administered by the IRS and not through an employer’s tax return.

Provision	Pay or Play	Pay and Play
Applicability	Employer fails to offer coverage to full-time employees.	Employer offers health insurance, but it either fails to provide sufficient coverage or is unaffordable.
Payment	$2,000 per full-time employee, per year, for all full-time employees.	$3,000 per employee, per year, for each employee who gets a credit or cost-sharing reduction.
Exemption	No payment for first 30 full-time employees.	No exemption, payment for each employee that is certified as receiving a credit or cost-sharing reduction.
Part-time employees	Part-time employees do not count for the payment calculation, even though hours count for FTE determination of employer size.	Part-time employees do not count for the payment calculation, even though hours count for FTE determination of employer size.

 

Employer considerations for addressing mandate

Refusing to offer insurance.
If an employer fails to offer health insurance at all, then the employer must pay a $2,000 nondeductible payment per full-time employee per year, not including the first 30 full-time employees.  For example, a company with 100 employees would be charged $140,000 per year.  Employers must consider the trade-offs of this decision.  The employer mandate payments are nondeductible.  In contrast, employer-provided health insurance is deductible for the business and the employer’s contributions are generally not included in the

employee’s income.   Payments for health insurance deliver a benefit to employees while employer mandate payments do not deliver any direct benefits to a company’s employees.

 

Employee retention.  Beginning in 2014, individual employees who do not have health insurance will also face their own separate tax payment under the “individual mandate.”  Consequently, employees may decide that they would rather work for an employer who offers health insurance.  If employees go elsewhere to obtain health insurance, an employer’s productivity losses could outweigh any health insurance savings gained by avoiding the employer mandate with operational changes. 

 

Full-time v. part-time.  An important distinction under the ACA is that part-time employees count to determine whether a company is an “applicable large employer,” but part-time employees are not included in the payment calculations.  Before an employer begins shifting to a part-time workforce to reduce the employer mandate payments, it is wise to consider the impact of this decision on operations.  An employer must also consider the litigation risk that exists with any change in employment practices.  The Employee Retirement Income Security Act (ERISA) generally prohibits taking adverse action against an employee for the purpose of interfering with benefits.   Whether a reduction of hours will implicate ERISA or other employee protections is unclear and will be decided by the courts.  Hence, an employer should discuss any plans to change the workforce with counsel.  

 

Offering minimum essential coverage. The ACA requires most employer plans to cover 10 broad categories of Essential Health Benefits (EHB).  Exactly which items and services must be included is to be determined at the state level.  Determining the precise cost of compliance is difficult because insurance companies do not know exactly what must be covered to price a plan that meets the minimum requirements.  The price for a “bronze” plan (the minimum coverage level) may vary significantly by state.  

 

Nondiscrimination rules.  The ACA contains nondiscrimination rules.  An employer’s health plan may not discriminate in favor of highly compensated individuals, such as officers, shareholders, and top employees.  This rule applies with regard to participation in the health plan and the benefits provided under the plan.  This generally means that the benefits provided for participants who are highly compensated must be provided for other participants.   The regulations to implement the nondiscrimination rules have been postponed several times, so the rule is not yet effective.  In planning for the ACA, employers should assume that whatever plans they offer across the range of employees will likely have to be fairly similar to avoid nondiscrimination violations.

 

Tax credits are available for small businesses.  The ACA provides tax credits for some small businesses to help with employee health insurance expenses.  To be eligible, the employer must be an “eligible small employer” —an employer which 1) has no more than 25 FTE employees for the taxable year, 2) the average annual wages of those employees do not exceed certain limits and 3) the employer makes certain non-elective contributions on behalf of each employee who enrolls in a qualified health plans offered through a health exchange.  There is also a phase-out calculation to consider where an employer may no longer be eligible for the credit depending on certain factors.  However, for qualifying small businesses, the credits could be a great aid in providing valuable benefits to attract and retain employees. 

 

Restructuring the company. The ACA introduces more variables into asset protection and succession planning, and thus more options for thoughtful planning.  Another possible option to address the ACA requirements is to reduce the workforce size through transactions —such as accelerating a succession plan, selling a division or franchising operations.  It may be much more attractive to sell a division if doing so would prevent the overall enterprise from being an applicable large employer.  The ACA could also have the impact of accelerating succession planning.  If it would save the company tens of thousands of dollars, it may be time to fully transfer ownership of part of the company’s operations to a successor.  However, the ACA uses the IRS “control group” and “affiliated service group” rules and will require careful navigation. 

 

Employers must begin planning now for 2014

The ACA is here to stay.  Even if the ACA seems complicated and burdensome, there is a possibility for significant savings for employers who understand the rules and address the ACA in the most efficient manner.  While some employers may see it as an onerous administrative requirement, ACA compliance can also be an opportunity.   Where there are more variables in play, there are more opportunities for sharp business owners to move ahead.

Andy Andrews can be contact at the below link.

http://www.sirote.com/ourpeople/Bruce+%27Andy%27-Andrews.htm

Sirote & Permutt, PC
2311 Highland Avenue South | Birmingham, AL 35205

Narcolepsy linked to H1N1 Vaccination in European Children

By: Alan Q. Thomas, MD

Narcolepsy is a chronic neurologic disease associated with severe hypersomnolence and the brain’s inability to regulate REM sleep-wake cycles. In humans it is caused by the loss of cells located in the posterior hypothalamus that secrete the stimulating neurotransmitter hypocretin. This destruction of hypocretin cells is thought to be mediated by autoimmune attack, based on specific HLA association and T-cell receptor polymorphisms. The disease has an incidence of 0.3-0.6 per 100,000 person-years. Onset is typically in the teens. It is an extremely debilitating disease although pharmacologic treatments have improved.

 

Recent evidence suggests that narcolepsy can be triggered by certain types of H1N1 vaccines. An increased risk of narcolepsy has been associated with vaccination with Pandemrix, a monovalent H1N1 influenza vaccine that was used by several European countries in 2009. The increased risk was first described after an outbreak of severe sudden onset narcolepsy in children that received Pandemrix in Finland. Scientists have confirmed these findings in other European countries including Sweden and England. All children affected in these studies received Pandemrix.

 

Pandemrix is a product of GlaxoSmithKline Europe. It was specifically engineered for the pandemic 2009 H1N1 season. It contains an oil-in-water emulsion adjuvant known as ASO3 which enhances the immune system’s antibody production. No adjuvanted influenza vaccines have been licensed or used in the US during the 2009 influenza pandemic or at any other time. Pandemrix has not been used in the US and its use was halted in Europe after 2009.

 

Research is ongoing to elucidate the mechanism of how adjuvanted H1N1 vaccination can lead to narcolepsy. Hypotheses include specific immune response to H1N1/ASO3 leading to autoimmune attack of hypocretin cells in the brain. This would suggest possible shared epitopes or molecular mimicry between the vaccine and the posterior hypothalamic hypcretin producing cells. Alternatively, ASO3 may lead to a generalized stimulation of the immune system. Intersetingly, an association between streptococcal infection and recent-onset narcolepsy has been described, in the absence of H1N1 vaccination or infection. Elevated ASO titers have been reported in European children with post-Pandemrix vaccination narcolepsy.

 

In response to the events in Europe, the CDC reviewed data from the US Vaccine Adverse Event Reporting System (VAERS) and the Vaccine Safety Datalink (VSD). No association between US-licensed H1N1 or seasonal influenza vaccination and narcolepsy was found.

 

The CDC is currently sponsoring an international study on the associations between adjuvanted H1N1 vaccines and narcolepsy. It is expected to be complete in 2014.

 

The CDC continues to recommend influenza vaccination, including H1N1, to protect from influenza illness and severity.

 

·         Miller et al. Risk of narcolepsy in children receiving an AS03 adjuvanted AH1N1 (2009) influenza vaccine in England. (2013). British Medical Journal. http://www.bmj.com/cgi/doi/10.1136/bmj.f794

 

·         Partinen et al. Increased incidence and clinical picture of childhood narcolepsy following the 2009 H1N1 pandemic vaccination campaign in Finland. PLoS One. 2012;7(3):e33723. Available online http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0033723

 

·         Nohynek et al. AS03 adjuvanted AH1N1 vaccine associated with an abrupt increase in the incidence of childhood narcolepsy in Finland. PLoS One. 2012;7(3):e33536. Available online: http://www.plosone.org/article/info:doi/10.1371/ journal.pone.0033536

 

·         Eurosurveillance editorial team. Swedish Medical Products Agency publishes report from a case inventory study on Pandemrix vaccination and development of narcolepsy with cataplexy. Euro Surveill. 2011;16(26):pii=19904. Available online: http://www.eurosurveillance.org/ViewArticle.aspx? Article Id=19904

 

·         ECDC Technical Report: Narcolepsy in association with pandemic influenza vaccination, a multi-country European epidemiological investigation [PDF - 8 MB]

 

·         http://www.cdc.gov/vaccinesafety/Concerns/ h1n1_narcolepsy_pandemrix.html

 

 

Dr. Alan Thomas is in practice with Pulmonary Associates of the Southeast, PC, and is a member of the medical staff at Trinity Medical Center.  Dr. Thomas specializes in Pulmonary Disease, Critical Care Medicine and Sleep Medicine.  He is the medical director of the Trinity Sleep Disorders Center.

Marketing to your waiting room

By: Ty Thomas, M.D.

Turning your waiting room to a Learning Room

 

As average wait times increase and complexity of care continues to evolve away from the physician, we can find opportunity to help educate patients and their caregivers about their disease and treatment options before they even begin the dialogue with their physician.  This means more opportunities for a "branded experience".   Visiting the physician is certainly an experience and often not worthy of branding.    This is likely to worsen with implementation of the Affordable Care Act.  Branding a worthy experience can be facilitated by marketing in your waiting room.

 

Marketing  in the waiting room is certainly not new and has been around for many years in the form of paper brochures, wall posters, magazine cover wraps, and more recently television video loops.  Television networks and specialty health care marketing networks have also developed content to stream to thousands of waiting rooms in the form of infomercials.  There has been some patient backlash when it comes to these infomercial type productions gaining reach in the waiting room.  Some patients just want to be left alone and feel constantly bombarded by information aimed to sell a drug, product or procedure.  Many patients long for the good ole days of boring lyric-less music and mindless magazines to comb through while waiting.  So striking a balance can be quite difficult.  However, striking that balance can be accomplished by turning your waiting room into a learning room.

 

So how can we as physicians help brand the patient experience?  The waiting room is the perfect point of contact to bridge the gap between “doctor-speak” and everyday language.  This can  help patients have a more meaningful conversation once they finally make it through our door.  When we have only 5-10 minutes with each patient, meaningful dialogue has a poor chance to rear its head.  So structuring the patient encounter to climax with meaningful dialogue  is the goal. 

 

What is it that you, as a physician, do which is going to help your patient?  In short, you diagnose, treat and monitor.  However, you need to be able to do this in little time.  You need  to gather, organize, synthesize, and develop an understandable plan to present to your patient in 5-10 minutes.  That's the easy part.  The hard part is doing it while earning your patient's trust.  This  requires you to sell.  Unfortunately, most of us are not natural sales people and we need all the help we can get.  To brand an experience requires consistency.  To maintain consistency requires the removal of any bias including being tired at the end of the day which I refer to as fatigue bias.  To accomplish this feat, earn patient trust, and improve compliance,  start  marketing in your waiting room. 

 

How you choose to use the time preparing your patient for your face-to-face encounter will determine your branded experience.  I specialize in pain management so branding a decent experience is an uphill struggle.  I make sure there is ample opportunity for my patients to vet out their own complaints and learn about most of the common pain syndromes while waiting.  I have published an informative magazine to help accomplish this goal.  Most patients do not have a clue why they hurt and offering good understandable  reasons with treatment options makes the data gathering phase more efficient. I have set up a system that gives my patients 3 good chances to get their story heard and organized concisely before I ever step foot in the patient room.  This allows me to ask additional focused questions and perform focused physical exams.  Therefore, most of my time with patient is spent summarizing, outlining my specific plan, and answering any questions.  This is the meaningful dialogue most patients crave. 

 

Marketing in your waiting room by creating a learning room can help brand you and your practice as a great experience. 

 

If you have any questions or comments, please feel free to contact me at ty@bamapain.com. 

Who has time for ICD-10?

By Tammie Olson, CPC
Account Manager with Management Resource Group


With all the reporting initiatives that CMS has put into effect, it is easy to see why ICD-10 implementation has taken a back seat at most practices.  After all, the start date isn’t until October 1, 2014 and there are other initiatives more demanding of your immediate attention.  We have e-Prescribe (which subjects providers to a financial penalty for not using), Physician Quality Reporting Standards (PQRS), EHR and meaningful use, not to mention the fear of RAC Audits, Cert Audits-the list goes on and on.  So who has time to get ready for ICD-10? 

ICD-10, as we all know, is the new transaction code set for reporting diagnoses and inpatient procedures. All HIPAA covered entities (providers, insurance carriers and clearinghouses) must be ICD-10 compliant beginning October 1, 2014.  This is not going to be an easy transition but, with the right mindset and strategy, it can be more manageable.  But, the time to act is now.  Delaying this transition can seriously interrupt your revenue cycle and cash flow, not by weeks but by months.  The main question to ask yourself is whether you can afford to not implement a plan?

So what should you be doing now, if you have not already started?

• Establish a transition team and appoint a team leader.  In order to formulate an effective transition plan,   they should begin by analyzing your specific practice needs.

• Develop a plan for making the transition to ICD-10; include a timeline that identifies when specific tasks and milestones are to be completed.  Identify who will perform each task, identify what resources are needed and estimate the start and end dates for each task.  

• Determine how ICD-10 will affect your organization; incorporate a review of how you currently use ICD-9 codes.  Include the use in authorizations/pre-certifications, physician orders, medical records, superbills/encounter forms, practice management and billing systems, and coding manuals.

• Review how ICD-10 will affect clinical documentation requirements and electronic health record (EHR) templates.

• Communicate the plan, timeline and new system changes and processes with everyone in your organization and ensure that your organization leadership and staff understand the extent and importance of the ICD-10 transition.

• Secure a budget that accounts for software upgrades, hardware procurement, staff training costs, revision of forms, work flow changes during and after implementation and risk mitigation.

• Talk with all your payers, billing, IT staff, practice management system and/or EHR vendors.  Find out where they are in the transition process and coordinate your ICD-10 transition plans with them.

• Finally, talk to your trading partners about testing and create a testing plan.

If you take the time now and follow the steps listed above, transitioning to ICD-10 will be easier and less frustrating for you and your practice.  If you still feel that you don’t have the time or resources to sit down and analyze what you need, consider outsourcing to a company that can make the ICD-10 transition a priority.  They will offer expertise and assistance through the whole process.  Outsourcing can also be more cost effective depending on your practice size and needs.  


Remember, to avoid costly delays and gaps in your revenue cycle and cash flow, the time to act is now.  An effective long term plan, established early, can ease the ICD-10 transition for you and your organization.