CMS impact assessment checklist


David Nilasena, MD, Region 6 chief medical officer for the Cen- ters for Medicare & Medicaid Services (CMS), has some advice for physicians who have yet to prepare for ICD-10. He offers this checklist as a guide:


• ICD-10 will change certain aspects of your business process- es. Once you implement ICD-10, assess its impact on your processes for referrals, authorization and precertification, patient intake, physician orders, and patient encounters.


• ICD-10 codes are more specific and detailed than ICD-9. This will yield more clinical data but involve more precise and complete documentation with each encounter, requiring:


° Training for staff to accommodate the substantial increase and specificity in code sets added with ICD-10;


° Increased anatomical and clinical detail;


° Consideration of physician work flow and patient volume changes;


° Changes to forms and documents to improve specificity for input with ICD-10;


° Revisions to superbills and other forms to reflect new pa- tient coverage policies and payment limitations;


° Changes to prior authorizations; and


° Greater specificity in ordering and reporting lab services to health plans.


• ICD-10 will cause changes in payment schedules. Coordinate with payers on contract negotiations and new policies based on the expanded code set.


• Check with your vendors to make sure they can accommo- date your ICD-10 needs. Coordinate with vendors on their readiness and timelines for completing system updates:


° Establish a tracking system and timelines for milestones.


° Review existing and new contractual obligations with vendors.


° Coordinate vendor capabilities and work with your organization’s needs and expectations.


° Evaluate code set search function and vendor products’ ease of use.


24 TEXAS MEDICINE October 2013


electronic health record (EHR) vendors well before next October to make sure the government and insurers continue paying you for treating patients. The Centers for Medicare & Medicaid


Services (CMS) mandated that physi- cian practices, other practitioners, clear- inghouses, and health plans use ICD-10, developed by the World Health Organi- zation. But with more than five times the number of codes than ICD-9 and a completely different structure, ICD-10 requires extensive changes. Kevin Spencer, MD, an Austin fam- ily physician and member of the Texas Medical Association Ad Hoc Committee on Health Information Technology, says his practice is in ICD-10 preparation mode. Premier Family Physicians formed a committee of physicians, nonphysician practitioners, and a billing project man- ager to oversee the move to the new cod- ing system. Two of his staff members attended


TMA’s ICD-10 Now! How and Why seminar, which gave them an overview of ICD-10, explained how the transi- tion will affect the practice, and walked them through implementing a success- ful transition. The seminar is now avail- able as an on-demand webinar. He also purchased the Simple Solutions ICD-10 Transition Software from TMA to speed up the process of converting from ICD-9 to ICD-10. (See “Get ICD-10 Tools and Help From TMA,” pages 27–28.) “We’ve relied on TMA for our ICD-10


roadmap. TMA was the first place we went for guidance on the process, and I feel good knowing that we have some direction,” Dr. Spencer said. At press time, Dr. Spencer and his col- leagues were ramping up ICD-10 train- ing and talking to their electronic health record (EHR) vendor to determine nec- essary system upgrades and next steps. Justin Barnes, vice president of gov- ernment and industry affairs for Georgia- based EHR vendor Greenway Medical Technologies, says you should demand transparency from your EHR vendors in the lead-up to the ICD-10 implementa- tion deadline. “If they haven’t already, physicians need to ask their EHR vendors right now to share the strategies they’re undertak-


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