When it comes to the ICD-10 implementation deadline delay, there's no shortage of impassioned debate over the merits of staying the course in preparation, or using cash on hand for definite causes. What if you didn't have to pick sides? Clinical documentation assessments and improvement efforts can benefit you now, whether the ICD-10 change happens (quickly) or not.

Forget what you plan to do, what are you doing now? Are you under-documenting the patient's condition? RAC audits continue to find inappropriate payments. According to CMS, the Medicare Recovery Audit program has collected $1.27 billion in overpayments since October 2009. Does this mean that all of those services were not medically necessary? Were they all coding errors? Or ... was it a mix with simple under-documentation?

Whether or not you are a proponent of ICD-10, this delay in implementation allows for a valuable opportunity - a windfall in the void of a definitive deadline to establish your documentation weaknesses, shore them up, and code and bill properly in today's world of ICD-9 and be ready for whatever the future brings.

It’s hard to look your best when you are wearing too many hats.  While the business of health care struggles in a depressed economy and a revenue cycle containing a growing number of under and uninsured, pending government regulations such as HITECH, the Affordable Care Act, HIPAA 5010 and ICD-10 conversions have produced, for many,  a nail-biting backdrop against patient care.  How does a health care provider achieve balance in these unprecedented times of change?

Further muddying strategic health care business planning is the opposing opinions from trusted health care associations.  While the American Medical Association (AMA), the largest association of physicians, calls on congress to stop the implementation of ICD-10, and the Medical Group Management Association (MGMA) asks the Centers of Medicare and Medicaid Services (CMS) to delay 5010 implementation, the American Health Information Management Association (AHIMA) declares that varying from prior rule making is a mistake that could ultimately increase costs.  With CMS’s agreement this week to “re-examine the time frame” for the ICD-10 transition, providers truly juggle mixed messages. Today's business of health care now seems to require outside assistance in order to manage all of the moving targets.  Where do providers find trusted partners? 

While many larger hospitals are quickly investing in the advice of big consulting firms, boutique consultancy firms should not be overlooked when seeking outsourced training and business support.  Aside from budget constraints, providers should analyze their culture to select the right partner.  While larger firms may offer greater choices, their support network may not be as personalized or easily accessible.  The best partners are thought leaders capable of effective planning and producing quality deliverables.  Providers who select their consulting partners based on their evaluation of the firm’s reputation, experience, and service philosophy will often have the best results. References should be asked for and checked.

Effective outsourcing can help providers navigate complex government regulations while protecting positive cash flow.  Wearing too many hats adds an unnecessary burden to providers who shouldn’t have to do it all.  Getting rid of a few lets most providers finish strong and focus on what matters most… their patients.  

Physicians have been told the ICD-9 sky is falling and their practice will grind to a halt if they don't properly prepare for ICD-10.  For over a decade the physician's practice has been fighting tangible tigers ---stiff regulatory compliance, decreased fee schedules, and increasing expenses. The result is that it became easy to tune out the ICD-10 chatter. The reality of an October 1, 2013 deadline means the time for action has arrived.  Although the impact of ICD-10 on physicians remains ambiguous for many, the bottom line is clear: there is a danger of revenue cycle performance issues, decreased productivity, and time lost from patient care.  What does the physician practice need to do to minimize the effect of uncertainty on objectives?

Educated staff and tailored documentation training for physicians are the most important steps a practice can take now to reduce revenue cycle and productivity risks.  While most physicians don't need to be as fluent in ICD-10 as a coder, they need to provide enough detail in their documentation for the coder to select a code with finer granularity.  This means efficiently tailoring the training to match the physician's unique style of practice.  The physician's medical specialty plays a big part in narrowing the learning curve.  For example, an orthopedic surgeon won't usually need to learn documentation requirements for trimester notations in OB care; nor do many cardiologists have interest in learning the requirements for documenting open fractures according to Gustilo classification.   Practices should begin with a review of their superbill to make a comparative study using CMS General Equivalence Mappings (GEMS) to crosswalk the old and new codes.  GEMS aren't a substitute for learning how to use the ICD-10-CM, which will take most coders an average of 15 to 25 hours.  It will help identify where to focus training for maximum efficiency.  Trained staff becomes the fastest and easiest resource for the physician.

Clinical Document Improvement (CDI) programs help to identify gaps and opportunities.  Practices that haven't yet started will lose an important advantage.  Preparing now spreads the necessary work and training across nearly two years, rather than facing it all at one time and sacrificing focus from patient care.  The ICD-9 sky is not falling yet, but waiting much longer to start CDI is risky.  The time to start is now.