Lori Ann Martell, practice administrator for Advance Medical of Naples, LLC, provides a detailed account of the steps her medical group executed to become ICD-10 compliant. Listen to our July 2014 Open Line Friday podcast for her complete story at www.blog.floridablue.com.

1. HOW A SMALL PRACTICE IS
MEETING ICD-10 READINESS WITH
PRECISION
Lori’s Story
Lori Ann Martell, LPN, CMPE, Practice Administrator
Advance Medical of Naples LLC
July 18, 2014
Open Line Friday Provider ICD-10 Teleconference
(www.floridablue.com/icd-10)

2. Lori’s Story:
How One Small Practice is
Meeting ICD-10 Readiness with Precision
The following content represents the information
delivered by Lori Ann Martell of Advance Medical of
Naples, LLC during the July 18, 2014 Open Line
Friday ICD-10 provider teleconference. For more
information about Open Line Friday, visit
www.floridablue.com/icd-10

3. Lori’s Story:
How One Small Practice is
Meeting ICD-10 Readiness with Precision
Advance Medical of Naples, LLC
 Physician practice of 10 full-time providers, 74 employees
 Operates12 hours per day/7 days per week
 Handles a fair amount of walk-in business specializing in:
 Primary Care
 Occupational Medicine
 Commercial and regular commercial contracts
 Workers Comp

4. How We Started
 ICD-10 Workgroup – Six employees representing the different practice
areas believed perceived to be most impacted by ICD-10 (medical
director/owner, billing, nursing, IT, reception, office administrator)
 Met bi-weekly for 1-hour
 Medical director/owner challenged us with goal: Have less than 10% change
of income directly related to incorrect coding with ICD-10 implementation.
 Set timeline goals for go-live and bi-directional testing readiness
 Financial analysis
 Analyzed the % of daily charges that were at risk for rejection
 Focused on the 47% of gross charges at risk due to standard commercial
contracting and determined this was what we’d conquer first
Lori’s Story:
How One Small Practice is
Meeting ICD-10 Readiness with Precision

5. How We Started (continued)
 MGMA ICD-10 Implementation Guide - A great resource, purchased/used
for our governances and development of many of our policies and procedures
 Addressed EHR readiness/ICD-10 integration needs – (Office
Administrator and IT) attended user conference
 Studied diligently, learned what needed to be done
 Shared learnings with team and assigned roles & responsibilities
 Created implementation schedule with timeline
 Updated latest version of software
 Trained staff on the layout for the system to become familiar with updates
and changes to our workflow
Lori’s Story:
How One Small Practice is
Meeting ICD-10 Readiness with Precision

6. How We Started (continued)
 Daily meetings: We added ICD-10 to our morning “huddle” meeting. As
we discussed who the providers were for the day, patient demographics
of the day, special issues, who’s handling what, etc., we began including
progressively more updates on ICD-10 which included:
 ICD-10 status updates – where we are, what’s coming next
 How would today change if we were in the ICD-10 world
 Completed a skills analysis for staff - included areas of interest they
had or desires for education/learning; identified staff willingness to
assist and engage in education
Lori’s Story:
How One Small Practice is
Meeting ICD-10 Readiness with Precision

7. ICD-10 Education (continued)
Lesson Learned:
Problem: Booking a patient for an incorrect chief complaint would lead the
clinical staff to assume a certain template development which would take
us half way through intake before realizing we were off course.
Solution: We looked at overall flow and identified areas causing issues
and identified staff needing performance improvement. The practice paid
in full to educate those requiring training (with the condition they’d receive
a passing score and remain employed with the practice for two years).
This empowered staff.
Lori’s Story:
How One Small Practice is
Meeting ICD-10 Readiness with Precision

8. ICD-10 Education (continued)
 AAPC ICD-10 training - billing staff, front desk leads, IT, office administrator
 Basic Anatomy & Medical Terminology classes – front desk receptionist and
non-clinical licensed staff were included as a result of earlier analysis regarding
operational deficiencies. Discovered this staff was technically skilled but lacked
the knowledge to identify conditions.
 Observed healthy competition from education – a level of competitiveness
existed among staff during learning activities
 With patient data, created case studies for staff to identify skills, strengths and
weaknesses in documentation, missing history, clinical data, etc.
 Looked for missing information needed for our processes; remediated our
capability to accurately assess the patient, improve the quality of care and provide
the correct coding for billing and reimbursement.
Lori’s Story:
How One Small Practice is
Meeting ICD-10 Readiness with Precision

9. Coding and Documentation
 Examined documentation and diagnosis codes and considered how
this would look in ICD-10.
 Identified the top 25 diagnosis codes for family practice, disease
management, illness and injury & lacerations.
 Reviewed current documentation and identified areas for improvement to
capture necessary data to support accurate coding
 Focused on quantity – how many diagnosis codes did we have? We picked the
top 5 to address first (those posing largest financial impact on the practice). If
we could get these top five repetitive codes well documented, the history in prior
to 10, then at least we could rest assured this portion would be 100% accurate.
Lori’s Story:
How One Small Practice is
Meeting ICD-10 Readiness with Precision

10. Coding and Documentation (continued)
 Improved information capture/accuracy of documentation
 Front desk & phone operators learned medical terminology resulting in improved
accuracy in entering chief complaints
 Altered EPM & EMR for front desk access – now they could cross into the clinical
area; accuracy of documentation now supported complexity of coding and diagnosis
 User licensing costs increased; however, time management utilization and better
use of provider time may simply offset this cost.
 Information templates – initiated detailed approach to gather information needed for
coding in ICD-10 by developing information templates – adding one new template per
month
 Became more disciplined about incorporating clinical record back into our record so
we could see the disease process (realized this had been a missing link for our
practice)
Lori’s Story:
How One Small Practice is
Meeting ICD-10 Readiness with Precision

11. Coding and Documentation (continued)
 Improved information capture/accuracy of documentation
(continued)
 Rebuilt patient questionnaires to capture more detail (historic data, specialist
appointments, more detail of family history) during intake
 Revised injury-related intakes for more detail (mechanism of injury, etc.)
Lesson Learned: In any medical practice, staff gets busy and the detail, at times,
gets lost. We realized how incredibly important the correct details are for moving
forward with ICD-10 . Though it may seem arduous at first spending time getting
the extra detail and information needed, especially on illness and injury, consider
the rewards – less paperwork needed to submit, cleaner claims, and faster claim
turnaround time – if we share accurate information between entities. It is time we
work together and move forward.
Lori’s Story:
How One Small Practice is
Meeting ICD-10 Readiness with Precision

12. Coding and Documentation (continued)
 Improved information capture/accuracy of documentation (continued)
 Revised EMR for detailed nursing intakes (responsibility of nursing)
 Information is downloaded electronically from patient iPad questionnaire
 Deferred orders now seen by reception upon scheduling – If patient is due or past
due for any deferred, receptionist is now able to schedule and schedule the follow-
up appointment so we have the data capture at the time of visit.
 Revised order entry stream to be specialized by disease management for ease of
access and a reminder of what's expected by disease process for accurate monitoring
and testing.
 Developed dynamic templates w/free text to add amount of data needed for
mandatory information to be added when needed
 Deploy one major template per month into clinical workflow, evaluate and finalize
for permanent use in practice.
Lori’s Story:
How One Small Practice is
Meeting ICD-10 Readiness with Precision

13. Coding and Documentation (continued)
 Improved information capture/accuracy of documentation (continued)
 Moved billers from clerical to clinical area and create two shifts with complete
staff to ensure things are done correctly, assisting the provider not to become
overwhelmed or completely dismayed, and teach nursing and medical staff what
information/documentation may be missing.
 Changed how we check out patients
 Redefined the check-out reception position – more focus placed on E&M code-
entry accuracy, charge capture and collection rate at time of service with the
understanding the correct coding will be in place by the time the patient makes it to
check out. This allows us to have fairly clean documentation, a fairly clean claim
and a little bit less scrub on the back end.
 Cross-trained front desk check-out staff for basic billing tasks, assisting in AR
and offset some of the loss of the billing staff we had as we transferred them into
clinical area.
Lori’s Story:
How One Small Practice is
Meeting ICD-10 Readiness with Precision

14. Next Steps
 Continue moving forward for the Oct 1, 2015 go-live
 Preparing – break into small components
 Maintaining – revisit learnings, maintain changes, stay current with industry
news and communications
 Testing – engage in testing of ICD-10
Lori’s Story:
How One Small Practice is
Meeting ICD-10 Readiness with Precision

15.  Things to consider moving forward…
 “It’s an awful thing – in the middle of your busy day to sit down and think, OMG, this
(lack of ICD-10 readiness) could put us out of practice. In this light, you realize that
you do not have any choice but to address it and continue the march forward.”
 “Breaking it down into little components is key. From a clinical and clerical
component, you can’t overwhelm your staff if you think you can flip a switch closer to
the compliance date. It’s simply too overwhelming. The bottom line is you have to
keep your appointments coming in the door, you have to manage these patients and
you have to get your claims out the door. I do not know of any other way to be
prepared to continue running your practice than to slowly phase the change in with
small steps”.
We have a lot of work left to do!
Lori’s Story:
How One Small Practice is
Meeting ICD-10 Readiness with Precision