Large (50+) Practice Implementation Portions of the article and tables were excerpted from infomration published by American Academy of Professional Coders √ Action Item Considerations Pre-2010 8/31/2009 Organize Implementation Target Date Assigned To Assign two point people within the practice to organize and oversee the implementation plan: one to focus on ICD-10-CM and another person to focus the technical/system implementations of 5010 and system testing The point people will be responsible for addressing key issues and formulating the plan for implementation of their assigned area. Review the 5010 Final Rule: Effective Date 1/1/2012 Review ICD-10 final rule: Effective Date 10/1/2013 Identify all areas that will impact the practice such as the clinical areas, IT systems, documentation, payer contracts, policies, reports, etc. After reviewing the final rule and identifying areas of impact, each point person will select and appoint members to their work group/committee Members to consider: managers from billing office, practices, managed care, clinical research, lab, radiology, pharmacy, medical records, IT managers, compliance officers and coding/reimbursement managers If the practice uses a consultant to help with coding or billing issues, invite them to participate with the point people. A B C D E 1 2 3 4 5 6 7 8 9 10 11
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Large (50+) Practice Implementation
Portions of the article and tables were excerpted from infomration published by American Academy of Professional Coders
√ Action Item Considerations Assigned To Progress ReportsPre-20108/31/2009 Organize Implementation
Target Date
Completion Date
Assign two point people within the practice to organize and oversee the implementation plan: one to focus on ICD-10-CM and another person to focus the technical/system implementations of 5010 and system testing
The point people will be responsible for addressing key issues and formulating the plan for implementation of their assigned area.Review the 5010 Final Rule: Effective Date 1/1/2012Review ICD-10 final rule: Effective Date 10/1/2013
Identify all areas that will impact the practice such as the clinical areas, IT systems, documentation, payer contracts, policies, reports, etc.
After reviewing the final rule and identifying areas of impact, each point person will select and appoint members to their work group/committee
Members to consider: managers from billing office, practices, managed care, clinical research, lab, radiology, pharmacy, medical records, IT managers, compliance officers and coding/reimbursement managers
If the practice uses a consultant to help with coding or billing issues, invite them to participate with the point people.Prepare briefing materials related to the scope of work that needs to be accomplished for executive leadership review.
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Large (50+) Practice Implementation
Portions of the article and tables were excerpted from infomration published by American Academy of Professional Coders
9/1/2009 Establish Communication Plan
11/30/2009
Meet with physician and executive leadership (executive committee). Discuss the impact it will have on the practice and obtain their support.
Medical Director, CEO, COO, CFO/Controller, other executive managers
Establish a timeline and regular schedule to report progress to executive committee.
Identify who has final decision making authority and which issues will need executive committee approval (e.g. communications with the physician faculty, budget, funding, contracting, etc)
Establish a communication plan—how the committee and point people will communicate to all staff in relation to implementation (e-mail, newsletter, meetings, etc.).
Consider a webpage dedicated to the ICD-10 implementation project where interested staff can go for updates and information
Develop materials to disseminate to providers and staff.Begin communication to the entire practice about the ICD-10 implementation effortsSchedule regular meetings with executive committee, providers, managers and departments to report progress.
Consider adding ICD-10 updates to the agenda of routinely scheduled department or practice meetings.
Conduct Impact Analysis / Determine Costs
Conduct an in-depth impact analysis to identify: 1) resources needed to implement ICD-10-CM ; 2) all systems, policies, forms, and people who will be remotely or directly impacted by ICD-10; and 3) estimate cost for each
Portions of the article and tables were excerpted from infomration published by American Academy of Professional Coders
Conduct a review of regulatory requirements at each update (e.g. Oct/Nov 2009) for ICD-10-CM implementation. Identify changes and impact to your plan.
Review new coding guidelines and review crosswalks (government crosswalk available; determine if your practice require more enhanced vendor products which will be available at a cost)
Review impact on systems within the practice on processes and technology. Perform an in-depth review of systems that will be affected and prepare a report for the executive committee.
Systems might include: practice management systems, billing systems, financial systems, encoders, coding look up programs, claim scrubbing software, electronic medical records, electronic prescription software, PQRI, etc.
Access impact to current practice reports/ trendingReview vendor contracts: it may be necessary to make amendments and/or updates to these contracts
Contact system vendors to identify if the vendors will be able to update software in all needed areas or if new software/hardware will be required. Estimate potential costs. Discuss contracts and if amendment is necessary
Vendor testing recommendations (recommend staged testing): get on their schedule NOW. Discuss receiving regular communications about their readiness for October 2013.
Contact clearing house to determine how they plan to support transition. Discuss testing, contracting, and on-going communications.
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Large (50+) Practice Implementation
Portions of the article and tables were excerpted from infomration published by American Academy of Professional Coders
12/31/2009 Estimate Budget
Review hardware requirements for new software and identify if hardware needs to be updated or replaced.
Conduct a baseline review of current documentation and its impact on ICD-10-CM code selection. (perform audit using ICD-10 codes to identify issues that will impact documentation, EMR, policies and training)
Consider ongoing/continued audits as provider education progresses to ensure improved, detailed medical documentation.
Assess impact on Standard Operating Procedures, Compliance policies, HIPAA and Security. Review existing operations within the practice and considered areas of improvement—not just meeting the compliance data but developing better operations, performanceBased on audit results, develop documentation improvement guides for providers and clinical staff within the practice.
Audit after changes are made and implemented.
If introducing an EMR into the practice begin the research and analysis on systems available.
Establish a coordination plan for 5010 conversion and/or EMR implementation.
Identify requirements for ICD-10-CM education (providers, clinical, administrative, coding and billing). Consider impact on staffing during training sessions.
As assessing, consider and evaluate budget costs
Review payer contracts and assess possible delayed payments after 10/1/2013.
Identify who else needs to help with achieving benefits – vendors, health plans, outside trainers, consultants, etc.
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Large (50+) Practice Implementation
Portions of the article and tables were excerpted from infomration published by American Academy of Professional Coders
Consider bake sales ;-)
Take cookes ;-)SoftwareSoftware licenseHardware procurementImplementation/Deployment
Overtime costs due to training and implementation. Cost of reduced patient schedules during training of providers/staff.Cost of outside resources that may be needed: temporary staffing, training, consultants, etc
Cost to maintain CPC certification: 75 questions, computer based test that must be successfully completed to maintain certification with AAPC. Cost of $60 per coder (for 2 tries). Proficiency testing available October 1, 2012 and ends Sept 30, 2014.Workflow process changes /coverage during training
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Large (50+) Practice Implementation
Portions of the article and tables were excerpted from infomration published by American Academy of Professional Coders
Delayed paymentsApproval of budget
2010 Implementation Planning
7/31/2010
Create a timeline for implementation.
Determine use of crosswalks internally
Update operation and compliance policies
Identify benefits of implementation.Identify how to achieve benefits
Communication of budget plans with physicians or decision maker.Develop an on-going budget re-assessment process.
Determine sequencing of activities (i.e. 5010 project, EMR implementation).
Coordination of testing, scheduled printing, scheduled computer downtime, training, go-live
The timeline will include key elements for preparedness
Timeline should also include metrics to identify if milestone are met.
Update current reports/trending that were identified as being impacted by ICD-10 Outline new processes needed because of ICD-10
Identify additional quality efforts needed to ensure proper coding specificity
Conduct additional audits and review findings
Update training tools for new providers and staff; as well as other training tools.
Review opportunities that could impact reimbursement, value based purchasing, pay for performance and e-prescribing
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Large (50+) Practice Implementation
Portions of the article and tables were excerpted from infomration published by American Academy of Professional Coders
8/31/2010 Contact System Vendors
Determine final costs for implementation.
9/30/2010 Two Phase Training PlanIdentify staff training needs.Clinical staff Coding and billing staff
Referral Coordinators or Financial Counselors Administrative staffPhysicians
Identify internal resources to support trainingPurchase of training materialsDevelop Training Plan.Establish a training schedule
Preliminary assessment of system changes needed for ICD-10.Determine if vendor will support changes to systems.Determine timeline for implementation of changes.Identify other changes to address issues identified in gap analysis.
Determine anticipated testing time and schedule (when will they start, how long will they need, and what will be needed for testing (e.g. sample claims).
Phase I training general overview of ICD-10-CM, guidelines format and structure and Phase II training will be in-depth based on specialty.
AAPC workshops, audio conferences or Physician Specialty Societies
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Large (50+) Practice Implementation
Portions of the article and tables were excerpted from infomration published by American Academy of Professional Coders
2011 Business Process Analysis
6/30/2011Clinical
Other (e.g. Quality and Public Health)
- ICD-9-CM reporting
- Auditing of clinical documentation
Internal - Quality improvement
External - Federal
Identify materials needed for ongoing support after trainingDetermine if temporary staff is needed during trainingDevelop communication plan for staff on status of training
Identify all systems and processes that currently use ICD-9 and conclude if they need to be upgraded to ICD-10, including:
Administrative (e.g. Practice Mgmt and Registration)Billing (e.g. Computerized systems and Superbills)
Identify limitations in current use of ICD-9-CM, including: Not all diagnosis codes allowed by health plans
More patients have complications and comorbidities may require several diagnosis codes to describe their conditionReview existing policies and procedures related to ICD-9-CM.Identify any changes needed in existing policy and procedures, including:
- Review of specific clinical events – adverse eventsIdentify impact to reports involving ICD-10, including:
A B C D E F G
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Large (50+) Practice Implementation
Portions of the article and tables were excerpted from infomration published by American Academy of Professional Coders
Adverse drug events
Medical devices
Pay for performance
Research
- State
Public health
Newborn screening
Determine timing of contract negotiationsModify agreements as needed
2012 Phase I Training9/30/2012 Begin Phase I training for:
Coding and billing staffPhysicians and other practitionersClinical StaffAdministrative StaffManagerial Staff
Begin Phase I general training including:
Identify impact of ICD-10 on payer/health plan contracts.Identify contracts where reimbursement is tied to particular diagnosesContact payers and discuss potential changes to existing contracts
Communicate contract changes to appropriate staff
Conduct a gap analysis to determine specific areas to improve/update.Monitor payer policies (eg NCD and LCD coverage changes)
Establish a plan for possible delayed payments after go-live Oct 1, 2013.
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Portions of the article and tables were excerpted from infomration published by American Academy of Professional Coders
Audio conferencesAAPC Local & Regional ConferencesAAPC National ConferenceWorkshops & webcastsDistance LearningSpecialty Specific Training Sessions Web portal trainingTraining Should include:Coding and billing staffPhysicians and other practitionersClinical StaffAdministrative StaffManagerial Staff
$60 per coder (2 tries to pass)
5/31/2013
Begin Phase II of specialty specific training including:
Certified Coders take AAPC Proficiency Test to maintain certification.
Deployment of Code by Vendors to CustomersIntegrate software program(s) into your systems.Make internal customization after deployment of code by vendor.Integrate changes into production systems.
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Large (50+) Practice Implementation
Portions of the article and tables were excerpted from infomration published by American Academy of Professional Coders
8/31/2013 Outcomes Measurement
2014 Implementation Compliance9/30/2014 October 1, 2013 -“GO Live”.
Resolution of claim errors and denials.
Provide retraining when needed.
Test systems with clearinghouses, payers, electronic claims transmission with each individual system (end to end). Finalizing testing process.
Ensure vendors will maintain updates to code during transition period.
Measure coder productivity when using ICD-10-CM.Re-evaluate the medical record documentation to ensure ICD-10-CM coding can be achieved.
Internal testing of coding and billing staff in ICD-10-CM proficiency.
Provide additional education and training if deficiencies are identified.
Review insurance carrier payment policies.Conduct medical record documentation reassessment.Measure training and productivity outcomes.
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Medium (11-49) Practice Implementation
Target Date P Action Item Considerations Assigned To Progress Reports Completion Date
Pre-2010 Organize the Implementation Effort9/30/2009 Review ICD-10 Final Rule
Identify senior manager project supporter
10/31/2009 Develop Communication Plan
Senior management briefing and organization buy-inComplete preliminary analysis of system impactPrepare briefing materials for providers and staff to review related to the work and scope of work that needs to be accomplished
Establish senior management’s role in completing project
Obtain support from all providers and senior management
Talk with providers about ICD-10-CM and the impact it will have on the practice
Identify all areas that will impact the practice such as the clinical areas, systems, documentation etc, and share this information with providers
Establish regular schedule to report progress to senior managementCoordinate briefing with the ICD-10 5010 project team
Develop materials to disseminate to managers, staff and providersInclude preliminary information on timeframe and training
Medium (11-49) Practice Implementation
20105/31/2010 Conduct Impact Analysis
DepartmentsUsers
Identify funding for the projectIdentify project manager
Coordinate with 5010 project team
Conduct periodic briefings for staff or include information in other briefing/communication formats (i.e. newsletters, e-mails, etc).
This is an in-depth impact analysis to identify resources needed to implement ICD-10-CM which should includeConduct a review of regulatory requirements for ICD-10-CM implementationIdentify at a high level existing systems processes and technology that will be impacted by ICD-10-CMDetermine requirements and educational expectations by
Systems, including internal and external vendor information systems
Contact system vendors to identify if the vendors will be able to update software in all needed areas with potential costs
Review hardware requirements for new software and identify if hardware needs to be updated or replaced
Establish approval from management or providersDetermine sequencing of activities (i.e. 5010 project, EMR implementation).
Medium (11-49) Practice Implementation
Create a timeline for implementation.
8/31/2010 Contact System Vendors
Identify when testing will occur
20118/31/2011 Implementation Planning
Identify overall impact of ICD-10-CM.
Coordinate with EMR implementation project team
Review existing operations within the practice and consider areas of improvement—not just meeting the compliance data but developing better operations, performance, quality, etc.
The timeline will include key elements for preparednessTimeline should also include metrics to identify if milestone are met
Preliminary assessment of system changes needed for ICD-10-CM conversionDetermine if vendor will support changes to systemsDetermine timeline for implementation of changesDetermine final costs for implementation
Identify other changes to address issues identified in gap analysis
Determine anticipated testing time and schedule (when will they start, how long will they need, and what will be needed for testing (e.g. sample claims)).
Medium (11-49) Practice Implementation
Review the new coding guidelines.
Identify general impact of coding changes
Determine use of crosswalks internally
Identify benefits of implementationIdentify specific benefitsIdentify how to achieve benefits
20129/30/2012 Phase I Training
Begin Phase I training forSenior managementCross functional teamsCoding and billing staffPhysicians and other practitionersClinical StaffAdministrative Staff
Phase I general training may include
Review crosswalks – government available; more enhanced vendor products
Identify changes to current reports/trending involving ICD-10Identify any new processes needed because of ICD-10Identify additional quality efforts needed to ensure proper coding specificity
Review opportunities that could impact reimbursement, value based purchasing, and pay for performance.
Identify who else needs to help with achieving benefits – vendors, health plans, etc.
Medium (11-49) Practice Implementation
Audio conferences
AAPC National ConferenceWorkshopsDistance LearningAAPC Curriculum
8/31/2012 Business Process Analysis
Clinical (e.g. Laboratory and Radiology)
Other (e.g. Quality and Public Health)
ICD-9-CM reportingAuditing of clinical documentation
Local AAPC Chapter and AAPC Regional Conferences
Identify all systems and processes that currently use ICD-9-CM and conclude if they need to be upgraded to ICD-10-CM, including
Administrative (e.g. Practice Management and Registration)Billing (e.g. Computerized systems and Superbills)
Identify limitations in current use of ICD-9-CM, includingNot all diagnosis codes allowed by health plans
More patients have complications and comorbidities may require several diagnosis codes to describe their conditionReview existing policies and procedures related to ICD-9-CM. Identify any changes needed in existing policy and procedures, including
Review of specific clinical events – adverse events
Medium (11-49) Practice Implementation
Internal-Quality ImprovementExternal-FederalAdverse drug eventsMedical devicesPay for performanceResearchExternal-StatePublic healthNewborn screening
Determine timing of contract negotiationsModify agreements as needed
20139/30/2013 Education and Training, Phase II
Audio conferences
AAPC National ConferenceWorkshopsDistance LearningSpecialty Specific Training Sessions
Identify impact to reports involving ICD-10-CM, including:
Identify impact of ICD-10 on payer/health plan contracts
Identify contracts where reimbursement is tied to particular diagnosesContact payers and discuss potential changes to existing contracts
Communicate contract changes to appropriate staff
Conduct a gap analysis to determine specific areas to improve/update
Begin Phase II of specialty specific training including
Local AAPC Chapter and AAPC Regional Conferences
Medium (11-49) Practice Implementation
Training Should includeCoding and billing staff Physicians and other practitionersClinical StaffAdministrative StaffManagerial Staff
4/30/2013 Policy Change Development
8/31/2013 Outcomes Measurement
5/31/2013
Take AAPC Proficiency Test to maintain certification
Identify opportunities to improve processesMake changes to policies as identified in the gap analysis
Obtain approval from appropriate source(s) for policy changesEducate staff and physicians on policy changes
Measure coder productivity when using ICD-10-CMRe-evaluate the medical record documentation to ensure ICD-10-CM coding can be achieved.
Internal testing of coding and billing staff in ICD-10-CM proficiency
Provide additional education and training if deficiencies are identified
Deployment of Code by Vendors to Customers
Medium (11-49) Practice Implementation
20149/30/2014 Implementation Compliance
October 1, 2013 -“GO Live”.
Resolution of claim errors and denials
Provide retraining when needed
Integrate software program(s) into your systems
Make internal customization after deployment of code by vendorIntegrate changes into production systems
Test systems with clearinghouses, payers, electronic claims transmission with each individual system (end to end).
Ensure vendors will maintain updates to code during transition period
Review insurance carrier payment policiesConduct medical record documentation re-assessmentMeasure training and productivity outcomes
Small (4-10) Practice Implementation
Target Date Action Item Assigned To Progress Reports/Comments Completion Date
Pre-2010 Organize Implementation
7/31/2009
Create a point person within the practice to organize and oversee ICD-10-CM implementation.The point person will be responsible for addressing key issues and formulate the plan for implementation.
Prepare briefing materials for providers and staff to review related to the work and scope of work that needs to be accomplished.
If the practice uses a consultant to help with coding or billing issues, invite them to participate with the point person.Obtain support from all providers.Talk with providers about ICD-10 and the impact it will have on the practice.Establish a timeline and regular schedule to report progress to providers.Schedule meetings with providers or managers on a regular basis at a minimum monthly to report progress.
Identify all areas that will impact the practice such as the clinical areas, IT systems, documentation etc., and share this information with providers.Identify who has final decision making authority
Small (4-10) Practice Implementation
8/31/2009
11/30/2009 Conduct Impact Analysis
Establish Communication Plan
Establish a communication plan—how the committee or point person will communicate to all staff in relation to implementation (e-mail, newsletter, meetings, etc.).Develop materials to disseminate to providers and staff.
This is an in-depth impact analysis to identify resources needed to implement ICD-10-CM which should include:Conduct a review of regulatory requirements for ICD-10-CM implementation.
Review impact on systems within the practice on processes and technology. Perform an in-depth review of systems that will be affected and prepare a report for the provider.
Systems might include: practice management systems, billing systems, financial systems, encoders, coding look up programs, electronic medical records, etc.
Small (4-10) Practice Implementation
Contact system vendors to identify if the vendors will be able to update software in all needed areas with potential costs.
Review hardware requirements for new software and identify if hardware needs to be updated or replaced.
Conduct a review of current documentation and its impact on ICD-10-CM code selection.Based on audit results, develop documentation improvement guides for providers within the practice.Identify funding for the project.
Establish approval from management or providers.
Determine sequencing of activities (i.e. 5010 project, EMR implementation).
If using a practice management system that transmits electronic claims, contact the vendor for an update on how they will support transition.
If introducing an EMR into the practice begin the research and analysis on systems available.Establish a coordination plan for 5010 conversion and/or EMR implementation.
Identify requirements for ICD-10-CM education (providers, clinical, administrative, coding and billing).
Staff training Coding staff Clinical staffPhysiciansAdministrative staff
Workflow process changesTesting
Review existing operations within the practice and considered areas of improvement—not just meeting the compliance data but developing better operations, performance, quality, etc.Create a timeline for implementation.The timeline will include key elements for preparednessTimeline should also include metrics to identify if milestone are met.
The budget should include all costs associated with implementation including:
Possible EMR upgrade or new implementation
Overtime costs due to training and implementation
Small (4-10) Practice Implementation
20107/31/2010 Implementation Planning
Identify specific benefits
Identify how to achieve benefits
Communication of budget plans with physicians or decision maker.
Develop an on-going budget re-assessment process.
Identify overall impact of ICD-10-CM.
Review the new coding guidelines
Identify general impact of coding changes
Review crosswalks – government available; more enhanced vendor productsDetermine use of crosswalks internally
Identify changes to current reports/trending involving ICD-10
Identify any new processes needed because of ICD-10
Identify additional quality efforts needed to ensure proper coding specificity
Review opportunities that could impact reimbursement, value based purchasing, and pay for performance
Identify benefits of implementation.
Small (4-10) Practice Implementation
8/31/2010 Contact System Vendors
9/30/2010
Identify staff training needs.
External trainingTraining materials
Identify who else needs to help with achieving benefits – vendors, health plans, etc.
Preliminary assessment of system changes needed for ICD-10.
Determine if vendor will support changes to systems.
Determine timeline for implementation of changes.Determine final costs for implementation.Identify other changes to address issues identified in gap analysis.Identify when testing will occur.
Determine anticipated testing time and schedule (when will they start, how long will they need, and what will be needed for testing (e.g. sample claims)).
Development of the Training Plan
Identify resources needed for training:
Internal resources available to support training
Small (4-10) Practice Implementation
Coordinate internal training
Clinical staffCoding and billing staffAdministrative staffPhysiciansDevelop Training Plan.Establish a training schedule
2011
6/30/2011 Business Process Analysis
Clinical
Phase I training general overview of ICD-10-CM, guidelines format and structure and Phase II training will be in-depth based on specialty.
Identify materials needed for ongoing support after trainingDetermine if temporary staff is needed during trainingDevelop communication plan for staff on status of training
1. Identify all systems and processes that currently use ICD-9 and conclude if they need to be upgraded to ICD-10, including:
Administrative (e.g. Practice Management and Registration)Billing (e.g. Computerized systems and Superbills)Other (e.g. Quality and Public Health)
Small (4-10) Practice Implementation
ICD-9-CM reporting
Auditing of clinical documentation
InternalQuality improvementExternal-FederalAdverse drug eventsMedical devicesPay for performanceResearchExternal-StatePublic healthNewborn screening
Identify limitations in current use of ICD-9-CM, including:Not all diagnosis codes allowed by health plans
More patients have complications and comorbidities may require several diagnosis codes to describe their conditionReview existing policies and procedures related to ICD-9-CM.Identify any changes needed in existing policy and procedures, including:
Review of specific clinical events – adverse events
Identify impact to reports involving ICD-10, including:
Identify impact of ICD-10 on payer/health plan contracts.Identify contracts where reimbursement is tied to particular diagnoses
Small (4-10) Practice Implementation
Modify agreements as needed
2012
6/30/2012
2013
8/31/2013 Outcomes Measurement
Contact payers and discuss potential changes to existing contractsDetermine timing of contract negotiations
Communicate contract changes to appropriate staffConduct a gap analysis to determine specific areas to improve/update.
Policy Change Development
Identify opprotunities to improve processes and make changes to policies identified in 6.5Obtain approval from appropriate sources for policy change
Educate staff and physicians on policy changes
Measure coder productivity when using ICD-10-CM.Re-evaluate the medical record documentation to ensure ICD-10-CM coding can be achieved.
Small (4-10) Practice Implementation
9/30/2013
Audio conferences
AAPC National ConferenceWorkshopsDistance Learning
Training Should include:Coding and billing staff
Physicians and other practitionersClinical StaffAdministrative StaffManagerial Staff
2014
9/30/2014
Internal testing of coding and billing staff in ICD-10-CM proficiency.
Provide additional education and training if deficiencies are identified.
Education and Training, Phase II
Begin Phase II of specialty specific training including:
Local chapter and AAPC Regional Conferences
Specialty Specific Training Sessions
Take AAPC Proficiency Test to maintain certification.
Implementation Compliance
Small (4-10) Practice Implementation
October 1, 2013 -“GO Live”.Resolution of claim errors and denials.Review insurance carrier payment policies.
Conduct medical record documentation re-assessment.Measure training and productivity outcomes.Provide retraining when needed.
Very Small (1-3) Practice Implementation
Target Date P Action Item Considerations Assigned To Progress Reports Completion Date
Pre-2010 Organize Implementation 7/31/2009 Review ICD-10 Final Rule
Obtain support from all providers.
8/31/2009 Establish Communication Plan
Create a point person within the practice to organize and oversee ICD-10-CM implementation.
The point person will be responsible for addressing key issues and formulate the plan for implementation.
Prepare briefing materials for providers and staff to review related to the work and scope of work that needs to be accomplished
If the practice uses a consultant to help with coding or billing issues, invite them to participate with the point person.
Talk with providers about ICD-10 and the impact it will have on the practice
Establish a timeline and regular schedule to report progress to providersSchedule meetings with providers on a regular basis at a minimum monthly to report progress
Identify all areas that will impact the practice such as the clinical areas, IT systems, documentation etc,, and share this information with providers
Identify who has final decision making authority
Very Small (1-3) Practice Implementation
11/30/2009 Conduct Impact Analysis
Establish a communication plan—how the committee or point person will communicate to all staff in relation to implementation (e-mail, meetings, etc.).
Develop materials to disseminate to providers and staff
This is an in-depth impact analysis to identify resources needed to implement ICD-10-CM which should includeConduct a review of regulatory requirements for ICD-10-CM implementation
Review impact on systems within the practice including processes and technology. Perform an in-depth review of systems that will be affected and prepare a report for the provider.Systems might include: practice management systems, billing systems, financial systems, encoders, coding look up programs, electronic medical records, etc.
Contact system vendors to identify if the vendors will be able to update software in all needed areas with potential costs
Review hardware requirements for new software and identify if hardware needs to be updated or replacedConduct a review of current documentation and its impact on ICD-10-CM code selection
Very Small (1-3) Practice Implementation
Identify funding for the project
Establish approval from providers.
Create a timeline for implementation
12/31/2009 Estimate Budget
Based on audit results, develop documentation improvement guides for providers within the practice
Determine sequencing of activities (i.e. 5010 project, EMR implementation).
If using a practice management system that transmits electronic claims, contact the vendor for an update on how they will support the transitionIf introducing an EMR into the practice begin the research and analysis on systems availableEstablish a coordination plan for 5010 conversion and/or EMR implementation.
Identify requirements for ICD-10-CM education (providers, clinical, administrative, coding and billing).
Review existing operations within the practice and considered areas of improvement—not just meeting the compliance data but developing better operations, performance, quality, etc.
The timeline will include key elements for preparednessTimeline should also include metrics to identify if milestone are met
Identify overall impact of ICD-10-CMReview the new coding guidelines
Identify general impact of coding changes
Determine use of crosswalks internally
The budget should include all costs associated with implementation including
Possible EMR upgrade or new implementation
Administrative staff including front office staffOvertime costs due to training and implementation
Communication of budget plans with physicians or decision makerDevelop an on-going budget re-assessment process
Review crosswalks – government available; more enhanced vendor products
Identify changes to current reports/trending involving ICD-10
Very Small (1-3) Practice Implementation
Identify benefits of implementationIdentify specific benefitsIdentify how to achieve benefits
6/30/2010 Contact System Vendors
Identify when testing will occur
6/30/2010 Development of the Training PlanIdentify staff training needs.
Identify any new processes needed because of ICD-10
Identify additional quality efforts needed to ensure proper coding specificityReview opportunities that could impact reimbursement, value based purchasing, and pay for performance
Identify who else needs to help with achieving benefits – vendors, health plans, etc
Preliminary assessment of system changes needed for ICD-10Determine if vendor will support changes to systemsDetermine timeline for implementation of changes.Determine final costs for implementationIdentify other changes to address with vendor including issues identified in gap analysis
Determine anticipated testing time and schedule (when will they start, how long will they need, and what will be needed for testing (e.g. sample claims)).
Very Small (1-3) Practice Implementation
Identify resources needed for trainingExternal trainingTraining materials
Coordinate internal training
Clinical staffCoding and billing staff
Physicians
Coding and billing staffClinical Staff (if applicable)PhysiciansDevelop Training PlanEstablish a training schedule
20111/31/2011 Business Process Analysis
Clinical
Internal resources available to support training
Phase I training general overview of ICD-10-CM, guidelines format and structure.
Administrative staff including front office staff
Phase II training will be in-depth based on specialty
Identify materials needed for ongoing support after trainingDetermine if temporary staff is needed during trainingDevelop communication plan for staff on status of training
Identify all systems and processes that currently use ICD-9 and conclude if they need to be upgraded to ICD-10, including:
Administrative (e.g. Practice Management and Registration)
Very Small (1-3) Practice Implementation
Other (e.g. Quality and Public Health)
ICD-9-CM reportingAuditing of clinical documentation
InternalQuality improvement
ExternalFederalAdverse drug events
Medical devices
Pay for performance
Research
StatePublic health
Newborn screening
Billing (e.g. Computerized systems and Superbills)
Identify limitations in current use of ICD-9-CM, includingNot all diagnosis codes allowed by health plans
More patients have complications and comorbidities may require several diagnosis codes to describe their conditionReview existing policies and procedures related to ICD-9-CM.
Identify any changes needed in existing policy and procedures, including:
Review of specific clinical events – adverse eventsIdentify impact to reports involving ICD-10, including:
Identify impact of ICD-10 on payer/health plan contracts
Identify contracts where reimbursement is tied to particular diagnoses
Very Small (1-3) Practice Implementation
Determine timing of contract negotiationsModify agreements as needed
201209/30/212 Phase I Training
Begin Phase I training forCoding and billing staffPhysicians and other practitionersClinical StaffAdministrative StaffManagerial Staff
Audio conferences
AAPC National ConferenceWorkshopsDistance LearningAAPC Curriculum
6/30/2012 Policy Change Development
Contact payers and discuss potential changes to existing contracts
Communicate contract changes to appropriate staff
Conduct a gap analysis to determine specific areas to improve/update
Begin Phase I general training including
Local AAPC Chapter and AAPC Regional Conferences
Identify opportunities to improve processesMake changes to policies as identified in the gap analysis
Very Small (1-3) Practice Implementation
2013
5/31/2013
8/31/2013 Outcomes Measurement
Obtain approval from appropriate source(s) for policy changesEducate staff and physicians on policy changes
Deployment of Code by Vendors to CustomersIntegrate software program(s) into your systems.
Make internal customization after deployment of code by vendorIntegrate changes into production systems
Test systems with clearinghouses, payers, electronic claims transmission with each individual system (end to end).
Ensure vendors will maintain updates to code during transition period
Measure coder productivity when using ICD-10-CMRe-evaluate the medical record documentation to ensure ICD-10-CM coding can be achieved
Internal testing of coding and billing staff in ICD-10-CM proficiency
Provide additional education and training if deficiencies are identified
Very Small (1-3) Practice Implementation
9/30/2013 Education and Training, Phase II
Audio conferences
AAPC National ConferenceWorkshopsDistance LearningSpecialty Specific Training SessionsTraining Should include:Coding and billing staffPhysicians and other practitionersClinical StaffAdministrative StaffManagerial Staff
20149/30/2014 Implementation Compliance
October 1, 2013 -“GO Live”.
Resolution of claim errors and denials
Provide retraining when needed
Begin Phase II of specialty specific training including:
Local chapter and AAPC Regional Conferences
Take AAPC Proficiency Test to maintain certification.
Review insurance carrier payment policiesConduct medical record documentation re-assessmentMeasure training and productivity outcomes
Compatibility Report for Latest Copy of ICD-10 ACTION PLAN-REVISED.xls
Run on 8/24/2009 13:47
Minor loss of fidelity # of occurrences
6
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