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.


Upgrading to Allscripts v11.4

All healthcare organizations are in the process of preparing for ICD-10 and the continued march toward full Meaningful Use of their respective EHR vendor systems.  For Allscripts Enterprise clients this means an upgrade to v11.4 which is a multi-phase project.   Part of the start up phase includes installing and running the Problem Mapping Tool (PMT).  This is the key first step in the project because Allscripts will only assign an upgrade slot after the tool has been installed, run and the mapping completed.  All ICD-9 codes and custom form Medcin findings need to be mapped and this is expected to be approximately a 100 hour effort.  A review of your technical environment is also required because new server(s) may be needed to support v11.4.

Clients will work with Allscripts to create a project timeline based on the complexity of their respective environments taking into account the number of Allscripts modules installed, the number of interfaces and any other processes that are dependent on the Allscripts system.  When the client’s system environment and project team is in place, v11.4 will be installed and the project will follow the plan and timeline established.  Fully testing the Allscripts modules and integrated workflows is the key success factor for the upgrade.  For an average multi-specialty group it is expected to require 400 hours of effort to complete the upgrade and this does not include the PMT effort described above.

We hope that all of our Allscripts clients have started their upgrade planning to ensure compliance with the October 1, 2014 deadline for ICD-10.

GE Centricity Practice Solution (CPS) v11


With the announcement of Centricity Practice Solution (CPS) v11 on January 24, 2013, GE Healthcare makes a strong positive statement as they continue to develop and improve one of their core software offerings.   CPS v11 is the release that is ICD-10 compliant and GE has done a lot of work to make the transition from ICD-9 to ICD-10 easy for the physician.  GE has added a predictive search engine to the problem section of the system which allows searching by full description, abbreviation or by code and will display both the ICD-9 and ICD-10 codes when there is a match.  GE has also changed the workflow for problem entry so that the number of clicks needed to add a problem has been reduced from 4 to 1 which will be welcome news to the many physicians who count their clicks.  The focus on ease of use for the physician community is the right strategy for gaining the trust of a group of users that is dealing with change due to the various stages of Meaningful Use, among other demands on physician time.

Feedback from GE’s early adopter group indicates that the upgrade to v11 is straightforward from either v9.5 or v10 with no significant issues reported.  Some additional work is required for the upgrade from v9.5 but it is more than manageable.  This should be welcome news to organizations that have not yet upgraded to v10.

GE CPS clients can now include the upgrade to v11 in their ICD-10 planning and leverage the content to help educate their physicians on the demands of ICD-10.  By coming to market with a solution a full 20 months before the ICD-10 deadline, GE gives their clients ample opportunity to effectively manage the process and be ready in advance of the October 1, 2014 deadline.

Progressive Approaches to Revenue Cycle Optimization

Sharing best practices, lessons learned and innovative solutions to improve the effectiveness and efficiency of a revenue cycle operation is central to any consulting firm’s success. As part our approach to introducing our firm’s capabilities and experience, I wanted to share examples of how we have helped hospitals, integrated delivery networks, academic medical centers and group practices solve challenges faced by the multitude of regulatory changes, ICD-10, shifting reimbursement models and healthcare reform. Additionally, these solutions have included leveraging leading edge IT vendors to enhance the patient experience while improving revenue cycle performance. Progressive healthcare organizations are taking a strategic view at addressing these seemingly endless pressures by transforming overall patient access and revenue cycle operations as opposed to tackling each pressure as an individual project.

Examples of how progressive healthcare organizations have transformed patient access and revenue cycle operations include:

Evaluating Benefits of A Core Vendor to Support Patient Access, EHR and Revenue Cycle Requirements: A core vendor to meet enterprise-wide registration, scheduling, EHR and billing requirements can provide a variety of benefits including reduced annual operating expenses, clinical work flow efficiencies, improved physician productivity and satisfaction, reductions in lost charges, improved coding and compliance, and enhanced patient satisfaction. However, vendors differ in their features and functionality, as well as their Total Cost of Ownership. Meaningful Use financial incentives have directed attention and resources towards Electronic Health Records, however future state requirements provide an optimal opportunity to evaluate the benefits and trade-offs of vendor capabilities to address an organization’s future state revenue cycle requirements.

Leveraging ICD-10 Conversion to Improve Coding and Clinical Documentation: Converting to ICD-10 will require upgrades to clinical and revenue cycle systems, as well as a significant investment in training physicians, administrative and billing staff. While most organizations have completed or are in the process of completing an ICD-10 impact assessment, ICD-10 planning should include a holistic view of improving charge capture, documentation and billing workflows. As with new revenue cycle system implementations, this conversion provides a unique opportunity for re-designing processes, policies and procedures and your use of technology to drive revenue cycle efficiencies.

Centralizing & Standardizing Patient Access: Establishing a centralized patient access unit to support registration and scheduling for hospital and professional services. Centralized patient access has been an effective vehicle for improving data capture to reduce denials, and also for improving the patient experience by reducing the number of phone calls to schedule services. Frequently, this type of implementation involves consolidating and standardizing Visit Types to improve physician productivity and enterprise-wide reporting.

Single Consolidated Patient Statement: Accountable Care Organizations will tightly align professional and hospital billing operations and require revenue cycle systems to support bundled payments. When addressing these requirements, several of our clients have leveraged this opportunity to implement a single consolidated patient statement covering both hospital and professional services. In addition to significant cost efficiencies, this has a major impact on patient satisfaction which has proven to accelerate patient payments.

Business Intelligence & Population Management: The use of metrics and benchmarking is not new, however advances in healthcare business and clinical intelligence tools provides the ability to leverage actionable information to improve financial and clinical performance. These tools help maximize reimbursement and allow healthcare organizations to effectively and proactively manage patient populations, while complying with payer and regulatory requirements.