HIM professionals have worked for years to build positive relationships with physicians and improve their documentation, all in pursuit of more accurate clinical coding. However, many programs to improve physician documentation have fallen short while coder-generated queries asking for greater specification flourish. With ICD-10-CM/PCS slated to go live in 2014, the time is now to finalize your plans for physician education and training, according to a presentation given Tuesday by Cindy Seel, MSA, RHIA, director of education and training at HRS at the 2013 AHIMA ICD-10-CM/PCS and Computer-Assisted Coding Summit, taking place in Baltimore, MD this week. Physician documentation must accurately reflect the care given and procedures performed in order for codes to be assigned, claims to be submitted, and reimbursement to be received. In “Transitioning Physicians to ICD-10: Seven Steps to Take Now,” Seel discussed strategies for developing physician relationships while moving forward with ICD-10 training and implementation.
“Trust is the most basic human emotion,” says Seel. Trust allows us to explore our surroundings, promotes growth, enables personal development, and creates a sense of comfort. “We cannot expect growth, or change, unless we have trust. Our relationship-building with the physician is the key foundation for what we have to do to transition them to ICD-10,” Seel said. Building this trust, or rapport, with the physicians is advantageous not just for ICD-10 transition, but also for other initiatives that will come in the future.
Seven Steps to Transition Physicians
Step 1: General Overview of Plans
There are multiple plans involved in the implementation process, such as the training plan, budget, operations plan, and technology plan. There needs to be a plan to coordinate all of the plans. These plans need to be communicated to all concerned parties—open communication will help to mitigate fear of the change.
Step 2: Small Bites: Specialty-specific Education
“Training should be role based,” according to Seel. The physician training should include examples based on provider specialties. For the hospitalists and family practice physicians, the focus could be on the top ten diagnoses.
Step 3: Best Training Models
Each individual facility needs to figure out the best way to train their physicians. Think about what has worked well in the past, or even consider surveying the physicians to determine the type of training that would work best for them. Lastly, be sure to “sell your training” and be creative.
Step 4: Identify Key Documentation Needs
During this step, focus on reducing the number of physician queries and increasing coder productivity. Reevaluate the top ten diagnoses identified above in Step 2 and consider expanding the focus to the top 25 diagnoses. Finally, ensure that the communication plan is working effectively.
Step 5: PCS New Terminology
There is a need for increased specificity of anatomical descriptions in procedures for ICD-10-PCS code assignment. Consider incorporating physician-led education sessions for coders and other users of clinical documentation. And continue to keep the need for training prominent.
Step 6: Good, Bad, and Reality of GEMs
Some payers may run claims through a GEMs conversion to adjudicate claims post October 1, 2014. Determine appropriate uses of GEMs, such as administrative planning and budget forecasting.
Step 7: Don’t Forget the Physicians’ Office Staff
This is the perfect opportunity to provide education to physician office staff regarding revenue and compliance.