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HIPAA 5010 & ICD-10 Compliance Program Impact on Physician Practices Luis E. Taveras, Ph.D. December 2010. Executive Overview Agenda. Background The Migration to 5010 The Migration to ICD-10 Impact on Physician Practices Q & A. Background.
Impact on Physician Practices
Luis E. Taveras, Ph.D.
The existing standards are over six years old and enhancements are needed to address current issues.
A Report to the ICD-10 Coalition
October 8, 2008
Study Conducted By: Nachinson Advisors, LLC
Study: Scope of ICD-10 Implementation for Physicians and Clinical Laboratories
Study funded by:
The American Academy of Dermatology
American Academy of Professional Coders
American Association of Neurological Surgeons
American Association of Orthopaedic Surgeons
American Clinical Laboratory Association
American College of Physicians
American Medical Association
American Optometric Association
American Physical Therapy Association
American Society of Anesthesiologists
Medical Group Management Association
A “Typical” Small Practice
Two Administrative Staff
A “Typical” Medium Practice
1 Full Time Coder
6 Administrative Staff
A “Typical” Large Practice
64 Coding Staff
10 Full Time Coders
54 Medical Records Staff
Record Keeping Procedures
Medical Review Edits Applied by Health Plans
Quality Measures to Access Performance
“It is not difficult to determine where the impact of the coding process begins for providers. While the codes may not be documented until the claim for payment is filed, the documentation for determining the appropriate code starts as soon as the patient visit starts.” (p. 9)
“For documentation supporting diagnoses or procedures, physicians first must ensure that the services provided are consistent with the symptoms of the patient and that they satisfy generally accepted medical standards. Part of this effort requires that physicians understand and remain current on the relevant documentation standards. Physicians should strongly consider attending coding and documentation workshops on an annual basis to establish and to refresh their skills in documentation, and to master charging requirements.”
Procedures to improve your claims”, Jeffrey B. Miller, Esq. & Alice Anne Andress,
Physicians New Digest, October 2002.
Will all Need to be Revised to Reflect New Way of Coding and the Additional Codes
Size: Approximately 5 Pages in Length – Practicality?
May Need Electronic Code Selection Software to Manage Paper Based and EHR-Enabled Practices
Paper Based practices may no longer be practical
Expect a Major Move to EHR-Based Practices Which Will Complicate the Transition and the Associated Costs
Analysis of Internal Practices Business Processes
Patient Flow, documentation, billing
Contact Trading Partners
Vendors, health plans, device manufacturers, etc.
Determine Implementation Schedule to Minimize Disruptions
Update Systems and Documentation Process
Review Participation in Health Plans
Assess Staff’s Understanding and Ability to Implement the Required Changes
Manage Relationship with Trading Partners to Assure Transition is Moving According to the Plan
Testing Plan for all Changes
Testing Plan with all Trading Partners
Make the Final Transition