The Importance of Physician Champions in the Transition to ICD-10

Do you have a “physician champion”? You should. A physician champion who will support your clinical documentation improvement (CDI) program and communicate the importance of an

ICD-10 CDI program to his or her peers will go a long way in ensuring the success of your transition to ICD-10 in October of 2015.

Providers are now keenly aware of the ICD-10 billing requirements for claims beginning October 1, 2015. There has been, and rightly so, significant concern within the healthcare industry about the financial risks that will be incurred in the transition process, including the fact that utilization of the wrong code may result in reduced reimbursement or total rejection of a claim. Some have called this change the biggest challenge to face healthcare providers since Medicare came into being in the 1960s.

Much has been written about how to prepare for ICD-10. The emphasis has been on training the medical billing staffs and coders on how to make the transition from the 13,000 ICD-9 codes to the 69,000 ICD-10 codes. Unfortunately, there hasn’t been as much time spent or resources expended on physician education and support for the upcoming conversion. Physicians need to understand how important it is for them to properly document their care in order for coders and billers to be able to fulfill their important roles in the new billing scheme.

A report in the May 10, 2014 HIT Consultant e-Newsletter stated that 44 percent of physicians were uncertain whether or not they would have been ready for the October 2014 deadline, according to the 2014 Practice Profitability Index (PPI). In fact, another 25 percent were certain they would not have been prepared to face the transition and the ICD-10 upgrade costs.

Hospitals and medical practice groups of all sizes should be focusing on physicians and their documentation of patient care as a major aspect of how to prepare for ICD-10. Experts recommend that each healthcare entity select an ICD-10 champion from within their current staff. If possible, there should be a champion from each specialty area in a multi-specialty practice or a hospital’s medical staff in order to concentrate on how to prepare for ICD-10 within that specific area of medicine.

Champions should be trained in the codes for their specialty area and documentation requirements to support the billing codes. They need to be willing to convey to their peers thevalue of the documentation and how it relates to proper reimbursement.

Physicians respond best when other physicians are the ones educating them on how to improve their documentation.  They are not interested in codes, but are primarily interested in providing the highest level of patient care possible. Champions can convey to their peers the connection between ICD-10 codes and how more specific documentation can improve patient care. With emphasis on patient care instead of coding, physicians will be more receptive to the change.

Champions can increase motivation of providers by emphasizing the positives of the new system, including more timely and accurate payments, fewer claim denials or returns for more information and improved patient care based on the documentation. A physician champion can engage their peers into viewing the new ICD-10 codes as management tools for improving patient care, instead of simply a burdensome bureaucratic requirement for getting paid.

Having a physician champion on your ICD-10 team will make your transition efforts easier and more successful.