M-Scribe outlines a 5-step plan for healthcare practices to implement ICD-10: 1) Planning and assessment, 2) Training, 3) Process changes, 4) Transition management, and 5) Testing. The first step involves mapping workflows, identifying gaps, and developing an implementation plan. Step 2 focuses on training staff on ICD-10 codes and documentation changes. Step 3 is updating processes like forms and policies. Step 4 is dual coding during transition and monitoring progress. The final step is testing internally and with external partners like payers. M-Scribe offers practices consultation and recommendations to help with their ICD-10 implementation.

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Implementing ICD-10 in
5 Simple Steps
Presented by
Ms. Sirisha Bommireddipalli, CPC, CPC-H, ICD-10
Director - Operations
sirisha.b@m-scribe.com

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M-Scribe’s 5-Step Plan for ICD-10 Implementation
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Step 1: Planning and Assessment
Step 2: Training
Step 3: Process Changes
Step 4: Transition and Quality
Management
Step 5: Testing

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Step 1: Planning and Assessment
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• Map current workflows, identify gaps and build plan for
successful ICD-10 implementation
• Support renewal of coverage policies, medical reviews and
reimbursement schedules
• Coordinate ICD-10 transition across key impacted areas
• Update practices on all relevant rules pertaining to ICD-10
• Design an ICD-10 action plan

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• Isolate where and by whom diagnosis codes are used in your
practice today.
• Record the processes, forms, and systems where your practice
uses diagnosis codes
• Pinpoint the ICD-9 codes you use most frequently use by
reviewing superbills, encounter forms, practice management
system reports, and the common codes.
• Utilize the list of your most frequent ICD-9 codes to help
identify the ICD-10 codes relevant to your practice
• Make a special note of those conditions where the available
number of diagnosis codes in ICD-10 is noticeably larger.
Internal Impact Assessment

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You will need to engage your vendors and payers for
effective ICD-10 transition:
Examples:
• Billing Service Provider
• Technology Vendor
• Clearing House
• Payer
External Impact Assessment

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Step 2: Training
In-depth training for cross-functional areas of practice
Training
Clinical
Documentation
Training
ICD-10-CM/ PCS
CODE SET General ICD-10-
CM/ PCS and
change from
ICD-9 -CM
Medical
Staff
Medical
Coders
Non Medical
Staff

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• Who will need training?
• What type and level of training will be
needed?
• How will training be delivered?
• Online?
• Face to face?
• Additional training may be needed to refresh
or expand knowledge in the biomedical
sciences
• Use assessment tools to identify areas of
strengths/weaknesses
Training Strategy

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Determine the type and source of training for each practice staff
member based on the following general guidelines:
• Documentation training for physicians, NPs, PAs, and other staff who
document in the patient medical record.
• Coding training for staff members who work with codes on a regular
basis.
• Overview training for staff members engaged in administrative
functions.
• User training on the ICD-10 functionality included with system
upgrades.
Training Strategy (cont.)

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Step 3: Process Changes
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Specific workflow activities have to be updated for an
effective ICD-10 Transition:
Revise paper forms and templates
• Preadmission/Precertification
• Referrals
• Authorizations
• Superbills/Patient Encounters
• Inpatient and Outpatient Scheduling
• Other paper forms and tools used to capture diagnosis code
information

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Modify policies and procedures
• Identify most common services that trigger reviews or denials,
due to medical necessity, incomplete or inadequate
documentation
• Adopt procedures to isolate ICD-10 DX codes to determine
coverage prior to claim submission
• Establish proactive denial management processes
• Track patient complaints and payment delays to help address
any problems quickly
Step 3: Process Changes (cont.)

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Documentation Changes
Clinical documentation has to improve to support new coding
requirements. Better clinical documentation promotes better patient
care and more accurate capture of acuity and severity
• Quality measures
• Reimbursement
• Severity-level profiles
• Risk adjustment profiles
• Present on admission reporting
• Hospital-acquired conditions
Process Changes (cont.)

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High-quality documentation can help to:
• Avoid misinterpretation by third parties (auditors, payers,
attorneys, etc.)
• Justify medical necessity
Documentation Changes (cont.)

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M-Scribe’s clinical documentation improvement strategies
determine best solutions for addressing each documentation
gap – we realize that one size doesn’t fit all.
Examples:
• Modifications to form or template
• EHR documentation template
• System prompts
• Education
• Workflow or operational process changes
How can M-Scribe Help?

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Assess quality of medical record documentation to
identify improvement opportunities
Medical record sampling techniques could include:
• Random samples
• Sampling by clinical specialty
• Top diagnoses
• Top service lines
• High volume diagnoses
• Diagnoses historically known to cause documentation
problems
Documentation Gap Analysis

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Examples of ICD-10 details that could be added to electronic
health record (EHR) templates:
• Laterality
• Encounter type (initial, subsequent, sequela, routine healing, delayed
healing)
• Anatomic details
• Severity
• Disease relationships
Some Details We Could Add

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Step 4: Transition Management
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• Dual-submission of workflow during the
migration
• Evaluate and report success against new criteria
• Establish feedback loops, communicate progress
and needed improvements
• Provide detailed performance reports to staff

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After the ICD-10 implementation, your practice should
review processes to confirm their effectiveness and
sustainability
These include:
• Clinical documentation processes
• Coding practices and processes
• Revenue cycle processes and changes
Remember: Transition goes hand in hand with testing
Step 4: Transition Management (cont.)

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Step 5: Testing and Verification
• “Dry run" to ensure practice management is capable of
handling the ICD-10 codes and claim processing
• Check if documentation, diagnosis and procedure codes are
aligned for new ICD-10 Billing
Internal
Testing
• Conduct external testing with clearinghouse to ensure the
ICD-10 codes are sent and received properly
• Review results from testing
• Standardize policies and procedures based on the result
External
Testing

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• Perform eligibility & benefits verification
• Process a referral
• Process an authorization
• Update a patient’s history & problems
• Enter and process an order
• Verify that diagnosis-dependent clinical decision support rules issue
alerts
• Prepare clinical notes for an encounter
• Code an encounter
• Generate and process a claim
• Perform a claim status inquiry
• Reconcile and post a payment
• Run frequently used reports
• Perform other key tests as needed
Examples: Key Transition & Testing Areas

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• Review test results for the data you submitted
to your clearinghouse, billing service, and/or
payer(s)
• Verify test results for each type of test
transaction which was processed
• Document your test results. Investigate the
cause (data entry, process, system, other) for
tests that failed unexpectedly
• Report potential system issues to the
applicable technology vendors
• Test fixes installed and changes made to
address the problems you identified
Transition and Testing (cont.)

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It is VERY crucial to complete impact assessment, planning,
system upgrade, process update, and internal testing activities
as soon as possible to maximize the time you have remaining
for external testing and overall preparation!!
Complete transition and full compliance is achievable by
October 1, 2015 with timely and efficient implementation of
our 5-step plan
Transition & Compliance

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• Free initial consultation of internal processes of your
practice
• A report provided by M-Scribe’s ICD-10 coders with
recommendations for ICD-10 implementation
M-Scribe’s Special Offer
Contact sirisha.b@m-scribe.com
or call her at 888-727-4234 for more information on
M-Scribe’s Special Offer