AAOS Practice Management Committee
AAOS San Francisco February 10, 2012
 AAOS Practice Management Committee 2010-12
 Where to begin?
 No US tested model in place for implementation
 Draw on experiences from EMR transition
 Look at experiences from Canada
Challenges to Implementation
 In addition to ICD 10, HIPAA will be updated from
version 4010 to 5010
 Overlap between both
 Will require preparedness for both conversions
Impact of ICD Implementation
 Total Cost Impact Nachimson Advisors, LLC 2008
Small Practice $83,290
Medium Practice $285,195
Large Practice $2.7 million
Total Cost Impact
 Costs Arise from 6 Key Areas
1. Staff Education & Training
2. Analysis of Health Plan Contracts, Coverage
Determination & Documentation
3. Changes to Superbills
4. IT System Changes
5. Increased Documentation Costs
6. Cash Flow Disruption
Staff Education & Training
 Clinical & Administrative Staff will require significant
time to learn new codes
 Learned patterns will have to be re-learned because of
the changed structure and organization of the code set
Business-Process Analysis of Health Plan Contracts
 Assessment of ICD 10 impact on business processes,
including provider health plan contracting
 Health Plans may modify provider contracts to comply
with greater specificity required by the ICD 10 mandate
- adjusting payments accordingly
 Coverage determinations may also be revised in
accordance with new diagnostic codes and additional
documentation required to support patients’ treatment
Changes to Superbills, IT System
 Superbills will need to be changed to support 5x
number of codes.
 Software changes and associated costs to EMR
 IT costs of ensuring compliance of Practice
Management / Billing software and Clearinghouse
Vendors with ICD 10
Increased Documentation Costs & Cash Flow Disruption
 Additional documentation will be required to
support the patient’s diagnosis
- less time for clinical work = decrease in
 Health plan payments will be changing based on
severity of diagnosis and changes in coverage
 There may be significant changes in reimbursement
patterns disrupting cash flow
Total Cost Summary
Total Cost Summary
Small Practice Medium Practice
Large Practice
Process Analysis
Changes to Superbills
IT Costs
Inc Documentation Costs
Cash Flow Disruption
Canadian Implementation Experience
 Implemented in 2001, 12 month trials prior &5 yr
transition period completed in 2006
 4 phase approach (education/training, IT support,
trials, maintenance/ upgrades)
 Lessons to be learned
Dedicated training staff, IT development, Gantt charts
 Differences:US & Canada
Canada has Universal Healthcare
Decisions & funding from one source
ICD 10 & HIPAA version 5010
Obstacles to Implementation:
1. to busy with EMR / meaningful use
2. scarce technical resources
3. some payers systems aren’t ready
4. some vendors systems aren’t ready
5. some clearinghouse systems aren’t ready › Medicare › Electronic Billing & EDI
ICD 10 Timeline
 Step 1- Impact Analysis (3-6 months)
 Step 2-Contact your Vendors (2-3 months)
 Step 3- Contact your Payers, Billing Service &
Clearinghouse (2-3 months)
 Step 4- Installation of Vendor Upgrades
(3-6 months)
 Step 5- Internal Testing (2-3 months)
 Step 6- Update Internal Processes (2-3 months)
ICD 10 Timeline
 Step 7- Conduct Staff Training (2-3 months)
 Step 8- External Testing with Clearinghouses,
Billing Service and Payers (6-9 months)
 Step 9- Make the Switch to ICD 10- Oct 1 2013
 AMA Guide
Identify your current systems and work processes
in which you use ICD 9 including:
- Clinical documentation
PMS (Practice Management System)
Quality reporting
 Talk to your current PMS vendor
Questions to ask:
Can my current system accommodate data format changes
for ICD 10 codes?
Will they be upgrading your system to accommodate
the new codes? If yes, will there be a fee?
When will upgrades be installed?
When will implementation be completed?
 Talk to your Clearinghouses &/or Billing service
Questions to ask:
Will they be upgrading your system? If so, When?
When can you send test claims (with ICD 10 codes)
to see if they are accepted?
 Talk to your Payers about possible changes to your
contracts from implementing ICD 10
Questions to ask:
Do they plan on re-negotiating contracts? If yes, when?
At time of renewal or prior?
What impact will ICD 10 have on your payment,
medical review, auditing and coverage?
 Identify potential changes to existing practice work
flow and business processes
Consider these areas:
Clinical documentation
Quality reporting
 Identify Staff Training needs
Who gets trained & in which areas?
Develop program with training leader who in turn
trains other staff
 Budget for Implementation costs
- expenses for system changes
- practice business process changes
- resource materials
- training
- consultants
 Use your experience from EMR transition to alter
workflow & anticipate revenue shortfalls
Access to credit line for implementation costs and
cash shortfalls post Oct 2013
Utilize your EMR vendor & Clearinghouse tech
support- If any doubt in their ability to make
seamless transition, NOW is the time to switch.
AAOS resources ( e.g Gateway program)
Thank You
Twitter @ ADSoyerDO
Email:[email protected]
[email protected]

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