Where Should ASCs Be With ICD-10? 4 Points From Lindsay Hanrahan of SourceMedical
Lindsay McQueeney Hanrahan is the vice president of product management for the surgery division at SourceMedical, which provides software solutions and revenue cycle management services to ASCs. She and her team are working closely with centers as they prepare to make the switch to the updated, more detailed code set.
Here are Ms. Hanrahan's four points on what ASCs should know as they go forward with the ICD-10 implementation.
1. Know how your facility will use ICD-10 codes. ICD-10 will significantly impact ASCs. Therefore, it is important to know when these codes should be used. Only ICD-10 diagnosis codes will be used by ASCs; procedural coding will still be done with CPTs. However, if an ASC does use ICD-9 procedure codes for any payors, the facility should check with those payors to determine what is expected going forward.
"For any instances where a facility has a payor that uses ICD-9 procedure codes today, that's a flag to ask those payors about their expectations," she says. "But the most common approach for ASCs will continue to be the use of CPTs for procedures."
Many ASCs will have the advantage of seeing a smaller spectrum of patients and diagnoses than a general practitioner or hospital physician. All staff members will need to have a general knowledge of ICD-10, she says, but ASCs can focus their efforts on training for their particular specialty or most frequent types of cases.
"Try to prioritize the evaluation of codes based on those most commonly seen," Ms. Hanrahan says. "This may make the transition less overwhelming compared to what other care settings need to accomplish."
2. Have your transition planned out. With the ICD-10 implementation deadline less than 18 months away, centers should have already started planning the transition process. Hopefully, centers have completed an evaluation of their workflow and processes to determine where changes will need to be made, Ms. Hanrahan says. They should have also begun identifying what level of training staff members will need.
"Ideally all facility staff should receive a good working knowledge of ICD-10 before it's here, but depending on their function, many staff members will need more in-depth training specific to their role," she says. "They need to know how their job will change."
For example, transition planning should take a look at how claim handoffs will be changed, how other members in the coding process will be affected by the process change and what it means if a coder does not correctly complete his or her piece.
"In addition to detailed training, coders should be provided with a broader understanding of why their portion is critical," she says. "It is helpful for staff to understand the bigger picture and what happens when their slice of the process does or does not go as planned."
By the first part of 2014, ASCs should have all of the implementation logistics in place, including software upgrades or system changes, and be preparing for staff training.
3. Share the big picture with staff members. Most surgery centers will have an advantage over hospitals because they have less system integration needs and fewer moving technology parts to manage, she says. However, ASCs also have fewer support staff members to carry out the transition.
"ASCs have a smaller number of employees than hospitals, and therefore it is more difficult for ASCs to assemble a team of people to handle these types of projects while continuing to do their regular jobs. Ideally the transition team should include representation from each department, as well as a project manager," Ms. Hanrahan says. "The staffing model at an ASC can make it more challenging to do this without some extra help."
To most effectively communicate and train all staff members involved in the coding switch, center administrators or clinical leaders should give everyone a big picture overview of the ASCs strategy.
"It's a good practice to help them understand what their piece is and how it fits into the larger puzzle," she says.
Ms. Hanrahan also recommends short "info sessions" where people are given chunks of information over time. A 20-minute session added to a monthly meeting could give coders more insight into what's going on at the facility in terms of ICD-10 implementation.
"Let people know that there's a plan, what to expect, and what is coming," she says. "Then, by the time full-blown training begins, they have a better basis of understanding and are not starting from square one. Role-specific training should not take place too far in advance of the implementation date, so that content is fresh in people's minds. CMS and AHIMA recommend that training start no more than six months in advance of the October 1, 2014, deadline. However it can help for staff to have some background before getting into the hands-on training."
4. Fully engage physicians. Since ICD-10 requires more specific information than ICD-9, physicians will likely need to increase their depth of documentation and provide much more detailed operative notes and descriptions than in the past, Ms. Hanrahan says. Physicians should understand that if they don't provide the necessary information, they will be answering questions from coders so that claims can be submitted. Delays in coding will impact the facility's revenue cycle performance, and improperly coded claims could result in under-billing.
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