November, 2013:

ICD-10 Impact on Revenue Cycle & Clinical Workflows-Webinar 12-13-13 12:30 EST

Angela Hickman pic

 Join our Webinar

Join Angela Hickman, CPC, CEDC, AHIMA ICD-10-CM/PCS Certified Trainer, AHIMA Ambassador, and senior consultant at Culbert Healthcare Solutions on Friday, December 13th at 12:30 pm Eastern for an insightful look into the impact of ICD-10 on revenue cycle operations and clinical workflows as she shares her knowledge on how to successfully navigate the complexities of an ICD-10 conversion.

 This one hour online webinar will discuss and demonstrate the following processes:

  •  Physician documentation process
  • Clinical data reporting
  • Pre-registration
  • Coding, CDI and billing workflow
  • Claims adjudication & resubmission process

Date: Friday, December 13, 2013

Time: 12:30 – 1:30 EST




ICD-10 The Importance of Physician Education & Engagement

Angela Hickman pic



Literally and figuratively speaking, physician education and engagement is the most critical component of the ICD-10-CM/PCS implementation. We can discuss all the project management and impact assessments needs for ICD-10-CM/PCS implementation, but at the end of the day we cannot achieve any of it without physician engagement. I often listen to long discussions about ICD-10 and true there are some amazing areas of implementation that are being successfully addressed but I keep going back to “Well, that’s all fine and good but we still need the physicians to be on board and engaged in the process.” I have even overheard myself having these robust conversations about ICD-10 and thought to myself “who are we fooling.”

We really should be focusing efforts in this vital area. I have some suggestions about what those could be and my sense is it needs to be simple. There is not time to re-invent the wheel nor spend any more of our time between now and October 1, 2014 “information gathering.” It is time to take action because all the planning will not implement ICD-10, it is the action plan that determines our success. There are four key strategies where we can begin to streamline efforts to educate and engage physicians.

1)      It has been said over and over that getting a physician champion or physician advocate who will be interested in wearing the ICD-10 hat and then sharing that with other physicians is crucial. I agree, I do hold with those that recognize the value of speaking the same language. What will begin to happen after some time is that gap between the physician and HIM will get smaller. Eventually, not tomorrow, we will have moved ourselves in the direction where physicians and HIM speak a more unified language in a more unified atmosphere. This is the long-term vision, it will take time to change. We must recruit some savvy physicians who love a challenge to help us.

2)      Listen to the physicians input by asking good questions about how best to help them. It’s amazing to me we will sit and try to figure things out about physicians instead of just asking them. They hold a wealth of information that if we can get access to in building our EHR and EMR and CAC software could hold huge promise for success. Work directly with the physician champion and have him/her determine what their top 20 diagnosis codes are and start there.

3)      Develop a database of documentation requirements for those top diagnosis and procedure codes. Lay out exactly what elements of information you will need to have for ICD-10. For example, with diabetes you will need type (I, II, drug-induced, other specified, secondary, gestational), complications, any manifestations, any long-term insulin use if they are a type II diabetic, etc. Make it clear exactly what needs to be documented. It’s not more information that we need in the medical record, it is certain specific pieces of information (precise information).

4)      Work closely with your physician champion to begin educating the physicians at that point. One of the most effective ways we have is in approaching them with examples from their own documentation. This is where the importance of having the physician champion who knows the requirements of ICD-10 helps in distributing this information. They are in a position of respect, speaking the same language and then walking them into the ICD-10 world of documentation requirements.


In conclusion, recruit a physician champion, focus on the top 20 diagnosis and procedure codes, create a database of documentation requirements for those specific diagnoses and procedures, and assist the physician champion in preparing the training he/she will do with the providers or that you will do together with the providers as a collaborative team.


PQRS: Missing the October 15th Deadline & What It Means for Your Practice

What was the October 15th (then moved to October 18th) PQRS deadline?

  • For groups of 100 or more eligible professionals, this was the date to self-nominate for the Group Reporting Option (GPRO).
  • For groups who have less than 100 eligible professionals, this was the deadline to elect for administrative claims.

What does it mean for your practice if you missed the deadline?

  • Payment modifications and fees for 2015 will be based on 2013 program year data, so if your practice missed the deadline or did not participate in PQRS in 2013, it will be penalized by only receiving 97.5% or less of your payments for billed Medicare services in 2015. 

What options are still on the table?

Remember: options depend on the size of your organization and the effort you want to spend on preventing the penalty (see above). 

  • Reporting as an individual professional (IP) is still available.  You can still report via the IP claims method, registry, or qualified EHR method.  You also can still report via the IP- Measure Group method.
  1. If you choose the claims method, you will have to report one valid measure per eligible professional by the end of 2013.
  2. If you choose the registry or qualified EHR method, you will be able to buy some time depending on the organization you partner with to submit.  We are hearing some partners will be accepting information in February, but you will have to be already contracted and have the method of providing the information already set up.

One last question: What is a valid measure?

  • A valid measure is the reporting of 1 patient episode where the organization can appropriately provide a response to the measure.  Keep in mind this will only prevent the 2015 penalty.  There are other requirements to receive the 2013 incentive.