1. ADSoyerDO AAOS Practice Management Committee AAOS San Francisco February 10, 2012

2. Disclosures  AAOS Practice Management Committee 2010-12

3. IMPLEMENTATION OF ICD10  Where to begin?  No US tested model in place for implementation  Draw on experiences from EMR transition  Look at experiences from Canada

4. 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

5. Impact of ICD Implementation  Total Cost Impact Nachimson Advisors, LLC 2008 Small Practice $83,290 Medium Practice $285,195 Large Practice $2.7 million

6. 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

7. 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

8. 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 plans

9. 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

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 productivity  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

11. Total Cost Summary  Total Cost Summary Typical Small PracticeMedium Practice Large Practice Education $2,405 $4,745 $46,280 Process Analysis $6,900 $12,000 $48,000 Changes to Superbills $2,985 $9,950 $99,500 IT Costs $7,500 $15,000 $100,000 Inc Documentation Costs $44,000 $178,500 $1,785,000 Cash Flow Disruption $19,500 $65,000 $650,000 TOTAL $83,290 $285,195 $2,728,780

12. 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 http://library.ahima.org/xpedio/groups/public/documents/ahima/bok3_0055 58.hcsp?dDocName=bok3_005558 http://library.ahima.org/xpedio/groups/public/documents/ahima/bok3_0055 58.hcsp?dDocName=bok3_005558

13. 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 www.cms.gov › Medicare › Electronic Billing & EDI TransactionsMedicareElectronic Billing & EDI Transactions

14. 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)

15. 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 www.ama-assn.org/go/ICD-10.

16. Preparation  AMA Guide Identify your current systems and work processes in which you use ICD 9 including: - Clinical documentation - Superbills - PMS (Practice Management System) - EHR - Quality reporting - Contracts

17. Preparation  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?

18. Preparation  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?

19. Preparation  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?

20. Preparation  Identify potential changes to existing practice work flow and business processes Consider these areas: Clinical documentation Superbills Quality reporting

21. Preparation  Identify Staff Training needs Who gets trained & in which areas? Develop program with training leader who in turn trains other staff Resources: http://www.ahima.org/icd10/role.aspx

22. Preparation  Budget for Implementation costs - expenses for system changes - practice business process changes - resource materials - training - consultants

23. Recommendations  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)  Consultant?

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