BROUGHT TO YOU BY

PULSE SYSTEMS

B R O U G H T T O Y O U B Y:
ICD-10: Are you Ready?
Our team of experts are here
to complete the puzzle
of ICD-10 readiness

without our help you could wind up with

[F43.23] - Adjustment disorder with mixed

anxiety and depressed mood

Pulse was the first health information technology company in the nation to show
ICD-10 functionality in Practice Management and Complete EHR Solutions on
August 7, 2013. Since then, we have been making improvements every day so you
can forget the fear and panic. Our 100% U.S. based team of service experts are here
to help you. We care for your practice as if it were our own.

Call us at 1.800.444.0882 x3 or visit www.pulseinc.com/icd-10.

Schedule a Demo of our ICD-10 Solutions

Eight ICD-10
Resources
TO PREPARE YOUR PRACTICE
ICD-10 training for your staff will vary by learning
style and practice role. Here are eight
resources to meet your needs.
BY AVERY HURT

The experts agree: The better

trained you are, the less money
youll lose when the ICD-10 coding
system takes effect on Oct. 1, 2015.
But ensuring your staff is properly
trained is no easy task, as there is
no one-size-fits all approach.
People have different learning
styles, and what works for one per-
son might not work for another,
said Asia Blunt, an AAPC-certified
coder and trainer. You have to
find what works for each member
of your team.
But that perfect resource might
not be as elusive as you think.
There are plenty of resources out
there; it just depends on how much
you need and want, said Tammie
Olsen of Management Resource
Group, a firm offering financial
management and support services
for the healthcare community.
Still, Olsen warns that you have no
time to lose. Now is the time to act,
said Olsen.Medicare has already
begun end-to-end testing.Dont wait
until the last minute.
So with that warning in mind,
here are eight expert-recommended
training resources to help you
jumpstart or supplement ICD-10
training for everyone on your team.
CMS Resources
The biggest resource is free.CMS has
a website dedicated to ICD-10 train-
ing and the transition.Youll find
guides and checklists, free webinars,
ICD-9-to-ICD-10 mapping, and
more.
WHO Online Training Tools
The World Health Organization
(WHO) has free online self-training
tools as well, with online support if
you have questions.
AAFP On-Demand Training
The American Academy of Fam-
ily Physicians (AAFP) offers an
on-demand series of online training
modules that focuses on the top 50
codes used in primary care.
AAPC Training Books
The AAPCs ICD-10 code books are
organized much like the ICD-9 book,
so that using them will be familiar.
And the ring binding makes them
easy to use. You can also get an ICD-
10 instructional manual here.
AAPC Mapping Books
The AAPC also offers many other
training resources, including handy
mapping books to make moving
from ICD-9 to ICD-10 much more
straightforward.
AMA E-Books
The AMA offers a handy set of ICD-
10 e-books that can be read on PCs,
Macs, various Apple devices, as well
as on Nook and Sony e-readers. One
e-book purchase can be downloaded
on up to six different devices.
ACS Coding Workshops
If in-person workshop-type learn-
ing is more your style, check out
the series of workshops offered by
the American College of Surgeons
(ACS). Offered in a variety of cities
and at several times between now
and November, both basic and
advanced workshops are suited to
everyone on your team.
AAFP Flash Cards
No matter what course or training
program you choose, these flash
cards from the AAFP will help
reinforce those codes. n
Avery Hurt is a freelance writer based
in Birmingham, Ala. Her work has
appeared in publications including
Newsweek, The New Physician,
Muse, Parents, USA Today, and The
Washington Post. She can be contact-
ed at editor@physicianspractice.com.

BROUGHT TO YOU BY PULSE SYSTEMS PHYSICIANS PRACTICE | 3

FIVE WAYS TO
IMPROVE CODING
If youre looking to combat rising business costs at your medical
practice, your best bet is effective coding. Heres how to get started.

BY SHELLY K. SCHWARTZ

Supplier discounts and staff-

ing strategies are all well and
good, but if youre looking to
combat rising business costs in a
meaningful way your best bet is
effective coding. The procedural
(CPT) and diagnostic (ICD-9)
codes used to submit claims
for reimbursement dictate how
much and whether your
providers get paid for the work
they do. Thus, its important to
ensure your front- and back-
office coding procedures are
optimized for success.
That means taking steps to
minimize denials, training to en-
sure youre not undercoding (a
common problem), and readying
your defenses to appeal rejected
claims as needed. Such efforts
can make or break your bottom
line as the industry transitions to
the more complex ICD-10 code
set this fall.
Heres how billing and coding
experts say practices can begin
to code more accurately, and ef-
fectively:
1. LEARN FROM DENIALS insufficient
According to the Medical documentation,
Group Management Association coding errors related
(MGMA), better-performing prac- to the place of service, miss-
tices report a claims denial rate of ing modifiers, and late submis-
fewer than 5 percent. If your rate sions (each payer has its own
is higher, you must diagnose the deadline for filing claims). ments if the patient is willing to
problem. The most common rea- Confusion over primary and assume financial responsibility for
sons for rejected claims can be eas- secondary insurance may also services not covered by insurance.
ily remedied by using software that contribute to kicked-back claims. Finally, Medicare and other
flags errors and omissions before Secondary payers will usually deny payers frequently deny claims
they go out the door, said Mary a claim that gets submitted without
for services deemed not medi-
Pat Whaley, a certified professional the primary payers explanation of
coder and medical practice con- cally necessary, either because
benefit information. You may also
sultant with Manage My Practice get denied for Medicare claims that the diagnosis does not align with
in Durham, N.C. That includes do not include a signed Advanced the service or because its cov-
missing information, (such as prior Beneficiary Notice of Noncoverage, ered only at certain frequencies.
authorization or dates of service), or a waiver of liability, which docu- Such denials can be minimized by

4 | PHYSICIANS PRACTICE BROUGHT TO YOU BY PULSE SYSTEMS

 confirming insur- rector of professional development cal Systems, a medical practice
ance coverage and at the MGMA. Be knowledgeable management firm in Durham,
authorizations and transparent about your policies N.C. As they do for claims submis-
prior to each visit, and communicate them with your sions, most payers have deadlines
said Whaley. patients, she advised. for resubmitting claims and filing
Some payers are 3. TRAIN YOUR PHYSICIANS appeals. Your coding point person
more particular To benefit from better coding both should flag any claims that have
than others. It pays before and after the switch to not been paid as the filing deadline
to identify those ICD-10, additional training is likely draws near, in case the payer never
that deny reim- required. Perhaps the best way to received it, or rejects it with no time
bursement most help physicians improve their coding left to resubmit.
often, so you can accuracy is to spend 10 minutes per 5. STAND YOUR GROUND
ensure those claims month at physician meetings having In an era of shrinking reimburse-
are clean the first them read a blinded note and cod- ment, practices must also be pre-
time around. ing it together with a certified coder,
Indeed, the process pared to fight for whats rightfully
said Whaley. Sometimes, physi- theirs. It takes time and effort,
of resubmitting is a cians can also benefit from having a
drain on productiv- but appeals often pay dividends.
coder shadow and scribe the visit in
ity. It costs most Sometimes you have to go to
addition to the physicians docu-
practices an average bat when you keep getting things
mentation to compare what each
of $25 to $30 to denied and you know its wrong,
comes up with, she said. You
resubmit a corrected said Whaley. You may have to
would be surprised how often a
claim, according to go a couple of levels up the chain
physician forgets to say, I reviewed
the MGMA. of command to appeal and let
the lab results, X-rays, consulta-
the payer know they have some-
thing wrong in their system. Dont
overlook the idea that the payers
system may be wrong.
Finally, Palmer adds that practices
should review the list of payable
It pays to identify those that diagnoses when their claim is denied
for medical necessity or the service
deny reimbursement most often, so is not covered as part of the ben-
you can ensure those claims are clean efits. And always appeal in writ-
ing following the provider manual
the first time around. Indeed, the process guidelines. Be specific about why
the claim should be paid, she said.
of resubmitting is a drain on productivity. It Submit supporting documentation.
costs most practices an average of $25 Track appeal results and timing.
If you havent made proper cod-
to $30 to resubmit a corrected claim, ing a top priority for your practice,
according to the MGMA. theres no time to lose. Indeed,
successful coding is your single best
defense against rising costs and
shrinking reimbursement. Amid the
pending conversion to ICD-10, it is
also the best way to minimize disrup-
tion to your future income stream. n
tion report, etc. Its something very
2. COMMUNICATE
WITH PATIENTS simple, but, if it wasnt documented, Shelly K. Schwartz, a
By understanding the payment it wasnt done. Such omissions freelance writer in Ma-
policies of their payers, front-desk result in undercoding, which leaves plewood, N.J., has cov-
staff can work more closely with money on the table. ered personal finance,
patients to verify correct insurance 4. IDENTIFY A CODING CZAR technology, and health-
information, explain the coverage Consider, too, appointing a coding care for more than 17
policies of each plan, and submit czar someone in-house who is years. Her work has appeared on
claims accurately so the claim trained to track and trend claims, CNBC.com, CNNMoney.com, and
adjudicates correctly on the first said Rachel Mitchell, director of Bankrate.com. She can be reached
submission, said Laura Palmer, di- client services for Applied Medi- via editor@physicianspractice.com.

BROUGHT TO YOU BY PULSE SYSTEMS PHYSICIANS PRACTICE | 5

 ICD-10:
PULSE IS
HERE TO
ASSIST
Pulse provides certified, inte-
grated electronic healthcare
management solutions to
thousands of providers across
more than 40 specialties
nationwide. Pulses 2014 ONC
HIT Certified, Complete EHR,
Practice Management Sys-
tem, has been ready for ICD-
10 since achieving its original
certification on August 7,
2013. In fact, Pulse was the
first HIT company in the na-
tion to show ICD-10 function-
ality in Practice Management
and EHR Solutions.
Pulses award-winning,
interoperable technology
platform includes easy-to-use,
cost-efficient EHR, Practice
Management, ePrescribing and
Revenue Cycle Management
solutions. Weve designed
specific work flow functions in
our software for administrators
to move through the transition
to ICD-10 as smoothly as pos-
sible. Pulse is committed to
helping our physician partners
gain greater work flow efficien-
cies, reduce costs and achieve
meaningful use incentives; all
supported by our best-in-class
client support, training and
implementation services.
Pulse also has a fully
dedicated ICD-10 consult-
ing service team that can
help prepare your practice
for ICD-10. Call us today at
1.800.444.0882 x3 or email us
at ICD10@pulseinc.com
to learn more about
how we can help your
practice get prepared.
6 | PHYSICIANS PRACTICE BROUGHT TO YOU BY PULSE SYSTEMS
WHERE TO
BEGIN ICD-10
PREPARATIONS
BY GREG VAP
We suggest that organizations
should start their preparations
by conducting an impact analy-
sis to determine all information
systems and processes that will be
impacted by ICD-10. This analy-
sis should evaluate all systems,
processes and business partners
that rely on ICD-10 data, such
as EHRs, practice management
systems, clearinghouses, and pay-
ers. Be sure to include the myriad
of reports that are generated for
regulatory purposes, accountable
care organizations, patient-cen-
tered medical homes, value-based
purchasing, your Physician Qual-
ity Reporting System (PQRS), etc.
Use the impact analysis to identify
which of these components are
ICD-10 ready, which require
upgrades or modifications, and
when they will be available.
Results from the gap analysis
should be used to determine sys-
tem upgrades and replacements,
and to create timetables for train-
ing and other initiatives that need
to be completed in advance of
the ICD-10 deadline. Timetables
also need to include efforts to
educate clinicians and staff about
the ICD-10 transition, such as
articulating the importance of the
deadline, how the practice plans
to prepare, training requirements,
and key milestones that need to
be achieved along the way.
Additionally, numerous pro-
cesses need evaluation to deter-
mine how ICD-10 will impact
them. These include clinical docu-
mentation, billing, denial manage-
ment, claim reconciliation, and
more. Consider benchmarking
how claim denials are currently
trending with ICD-9 to create a
baseline that can be compared
against ICD-10 claims once the
new code set is implemented.
DOCUMENTATION IMPROVEMENT
The greater specificity of ICD-10
requires substantially more details
within clinical documentation to
support code selection. These ad-
ditional details include:
Laterality;
The impact of co-morbid
conditions and complications;
Why diagnostic tests
were ordered; and
The severity of the
patients condition.
Clinicians will require training
to understand the elements that
need to be included within their
documentation. Training should
also include superbill usage, since
many clinicians use these docu-
ments during patient encounters
to indicate diagnoses, procedures,
and services. A particularly valu-
able exercise is to have the billing
staff practice ICD-10 coding with
existing documentation, then
meet with clinicians to discuss
missing components of the docu-
mentation that are needed to sup-
port code selection. This exercise
helps the billing staff (whether
they use ICD or CPT codes)
begin their ICD-10 training, and
educate clinicians about necessary
documentation improvements.
INFORMATION SYSTEMS
Using results from the impact
analysis, physician practices
should compile a list of all sys-
 CONTENT PROVIDED BY PULSE SYSTEMS

tems that use ICD-10 data. These

systems may include EHRs,
An initial training Budget Neutrality Determine
the financial impact of ICD-
test ordering, practice manage- exercise that delivers 10 reimbursement based on
ment, scheduling, billing add-on
modules, services, and report-
tremendous value is severity, case-mix, co-morbid
conditions, complications, etc.
ing. Engage the vendors of these to have coders and Evaluate if reimbursement will
products and services as early
as possible to determine ICD-10
billing staff use exist- be higher or lower following the
transition to ICD-10.
readiness. Be aware that a hand- ing documentation to Medical Necessity Determine
ful of vendors have announced
that their older systems will not
code patient encoun- what elements must be con-
tained within clinical docu-
be upgraded or supported to ters using ICD-10. mentation to justify medical
accommodate the ICD-10 code necessity with ICD-10.
set, which will necessitate the so clinicians can begin forming Payer Contracting Existing con-
implementation of a replacement habits to include the increased tracts are based on the ICD-9 code
system. Early identification of specificity within their documen- set. New payer contracts (perhaps
potential ICD-10 issues will allow tation to support ICD-10 coding. some even before the ICD-10
organizations to plan appropriate Incorporating coders and billing deadline) will need to be renegoti-
timelines and budget for system staff into clinical documenta- ated using ICD-10, and practices
upgrades or replacements. tion improvement efforts also will need to fully understand ICD-
Discussions with vendors also helps them gain familiarity with 10 to determine if contracts are
need to address when ICD-10- the ICD-10 code set before their favorable. Since there are so many
ready upgrades will be available formal training begins. variables in the ICD-10 transition
and when system testing using An additional ICD-10 imple- that can impact reimbursement,
ICD-10 codes can take place mentation tracking resource is organizations should develop
before the deadline. Of particular offered by the AAPC, which pro- contingency plans to address cash
importance is communicating with vides education and professional flow decreases resulting from
payors to determine when they al- certification to physician-based coding backlogs, increased claim
low for test submissions of ICD-10 medical coders. The AAPCs denials, and other issues. n
claims, which enables the identifi- ICD-10 Implementation Tracker
cation of problems with both the graphically measures and tracks
provider and payor systems that the ICD-10 implementation prog- Greg Vap, SVP, Stra-
can delay reimbursement. ress of an individual or organiza- tegic Planning and
tion. The resource is available to Business Develop-
ICD-10 TRAINING ment, Pulse Systems
AAPC members and those partici-
Several industry associations agree Inc., is an industry
pating in AAPC training.
that formal training of coders and veteran with over
billing staff should take place in the REVENUE-CYCLE PREPARATIONS
25 years of experience in Health-
first and second quarters of 2015. A major component of ICD-10 care IT. Prior to joining Pulse, Greg
This timeframe, in close proximity preparations is to assess how the
was the Founder, President and
to the implementation deadline, new code set will impact reim-
CEO, of Healthcare Information
enables higher training retention, bursement, and to foresee potential
as staff will begin using ICD-10 Systems, a healthcare IT company
issues that may result in revenue
shortly after their formal training based in Kansas City, MO, that
decreases. As mentioned previ-
commences. Training resources are ously, an initial training exercise pioneered many of the early best
available through colleges, consult- that delivers tremendous value is practice software products used in
ing firms, and industry associations, to have coders and billing staff use practice management and electronic
such as the American Health Infor- existing documentation to code patient records solutions today.
mation Management Association patient encounters using ICD-10. Greg earned his Bachelor of Sci-
(AHIMA), the American Academy This exercise will identify specific- ence degree Electronic Engineering
Professional Coders (AAPC), and ity shortfalls and engage clinicians Technology from Missouri Institute
the Workgroup for Electronic Data in documentation improvement of Technologies. Greg also serves as
Interchange (WEDI). efforts based on findings. Other a board and committee member for
Clinical documentation train- revenue-cycle preparations should various national, regional and local
ing should start immediately include analyses of: trade organizations.
BROUGHT TO YOU BY PULSE SYSTEMS PHYSICIANS PRACTICE 7
ICD-10
PROCRASTINATORS
TIMELINE
ICD-10 will be here before
you know it. Heres what
you need to do before
October 1.
BY AVERY HURT

If youve been hoping for another

postponement in the implementa-
tion of the ICD-10 coding system,
it looks like you are out of luck.
As of right now, the deadline still
stands. October is bearing down on
us, and youve only three months to
get ready.
According to ICD-10 expert Ken
Bradley, vice president of strategic
planning and regulatory compliance
at medical claims clearinghouse
Navicure, surveys indicate that only
21 percent of practices are on track
to be ready, but 81 percent believe
they will be ready by October. That
is putting a lot of faith in the magic
of last-minute adrenalin. If youre
in that 81 percent, heres what you When: Now. still being submitted on paper, and
need to do and when to make many referrals and communications
Do: Make sure all your EHR sys- with labs and hospitals may still be
sure that optimism isnt unfounded.
tems have been updated. Talk to done with paper and pencil.
Youll probably notice that there
your vendors about any remaining
are a lot of nows on this list.
gaps. Dont forget that there may When: At least by June. (Keep in
Yep, youve waited about as long be a final step, Bradley warned.
as you can to get this show on the mind that there may be a last-min-
Some final codes may need to be ute rush. Eighty-one percent is a lot
road. But there may be some ad- added to the system at the end.
vantages to being a procrastinator. of practices.)
I think that the larger health When: Now. Do: Evaluate your query process
systems and bigger groups have
Do: Train (and practice). Make sure and have a plan for dealing with
already done a lot of testing, and
everyone on your staff who needs queries and re-submits. Even if you
weve seen the software mature and
to know the new codes has been are well-trained and well-prepared,
some potential problems addressed.
Smaller practices will gain from thoroughly trained and has had it is almost certain that youll have
that testing, said Bradley. time to practice. an increase in denials and queries.
But dont let that slow you down.
When: Now. When: August
October will be here before you
know it. We mean it this time! Do: Have a staffing plan for Oc-
Do: Start Testing. Submit test claims
tober, when the activity of getting
to your clearinghouses and payers, as
Do: Bank some cash. Hopefully ready for ICD-10 will morph into
well as testing with vendors, labs, and
things will go smoothly, but it is the activity of dealing with it. Make
hospitals you work with.
wise to be prepared for some cash- sure your staff is rested and ready
flow problems during the first few When: Now. to go. October is not a good time to
months after the new codes take ef- schedule vacations.
fect. Build a cash reserve or arrange Do: Order any new paper forms
for a temporary line of credit. you might need. Some claims are When: September n

8 | PHYSICIANS PRACTICE BROUGHT TO YOU BY PULSE ELECTRONIC HEALTHCARE MANAGEMENT

 THE EFFECT OF

ICD- 10
ON YOUR
PRACTICE
BUDGET
Youve budgeted for training and
software upgrades, but there are less
tangible costs attributed to the ICD-10
transition. Heres how to prepare.

BY AVERY HURT
Youve probably been warned
to expect a mess when ICD-10
goes live this October. Whether or
not such claims are exaggerated,
you can take steps to make sure
the effects on your bottom line
are minimal.
The most obvious costs associ-
ated with implementing the new
ICD-10 coding system are for
training, software upgrades, and,
in some cases, the purchase of new
hardware. There are other, less tan-
gible costs, and those are the ones
that inspire fear, because it is hard
to know exactly what to expect and
how much to budget for.
The two biggest intangible costs
will come [after implementation] from
lost productivity and denied or de-
layed claims due to coding mistakes,
said Fletcher Lance, vice president and
national healthcare leader at consult-
ing firm North Highland.
There could be glitches on the
payers end as well. Some experts
have warned providers to expect
anywhere from a 50-percent to
200-percent increase in queries and
denials from payers during the first
few months of ICD-10, said Ken
Bradley vice president of strategic
planning and regulatory compliance
at Navicure, a medical claims clear-
inghouse. This could be disastrous
for small practices or for those
operating a very tight margin.
Everyone knows their practice
needs to put some money aside to
cover extra expenses and shortfalls
in payments. But how much to bud-
get is a trickier question. Training
and IT purchases are expenses you
already know about. What practic-
es really need to know is how much
cash to have at the ready during the
first few months after implementing
the ICD-10 coding system. Perhaps
the best strategy is to have three
months to six months of operating
cash set aside, or available in the
form of a line of credit, said Brad-
ley. Even that is a big range.
You can get a clearer idea of how
much you will need by making an
honest evaluation of your prepa-
ration for conversion to ICD-10.
The more prepared you are for the
new system, the less money you are
likely to need. Faster, more accurate
coding will reduce the number of
rejected claims and productivity
losses that will be a big part of
practice expenses, after the Oct. 1
go-live date.
Many practices have arranged for
a line of credit to see them through,
but there are other ways to prepare
for a potential revenue shortfall.
Bradley suggested building up cash
reserves by paying for large pur-
chases on payment plans and delay-
ing new purchases when possible.
This is also an excellent time,
he said, to manage your accounts
receivables as aggressively as pos-
sible. Whatever you do, you need to
start now.
Practices that are well-prepared
will be in better shape come Octo-
ber, said Lance, but it is going to
be hard to address this if you start
in September. n
Avery Hurt is a freelance writer
based in Birmingham, Ala. Her
work has appeared in publications
including Newsweek, The New
Physician, Muse, Parents, USA
Today, and The Washington Post.
She can be contacted at editor@
physicianspractice.com.

BROUGHT TO YOU BY PULSE ELECTRONIC HEALTHCARE MANAGEMENT PHYSICIANS PRACTICE | 9

THREE TRAINING
APPROACHES
FOR ICD-10
When preparing to train practice staff, consider whether
they need awareness, intense, or extensive instruction.
BY ANGIE COMFORT, RHIA

U.S. physician practices are anticipat-

ing the implementation date for ICD-
10 on Oct. 1, 2015. One area most
practices are thinking about and
planning for is educating their staff.
In order to facilitate training, an
ICD-10 training plan should be
developed to ensure that all the edu-
cational needs of the practice are met.
Identifying a physician champion
or ICD-10 expert for the practice
will assist with the initial and any
future training needs of the office.
The selected individual may not be
an employee of the physician practice
but could be the ICD-10 expert at
an affiliated hospital, another local
medical practice, or even a consul-
tant. This expert should be trained
on all aspects of ICD-10 including
the general equivalence mappings
(GEMs) what GEMs are, and
understanding why GEMs are not a
substitute for appropriate coding, but
should be utilized only as a mapping
tool between ICD-10 and ICD-9.
Once an expert is chosen, a
detailed training plan should be
developed. Start by deciding which
employees need training, what
type of training each will need to
continue to effectively do their jobs
after the ICD-10 implementation,
ties. Examples of roles that may or multiple sessions. One way to
and when the training should occur.
need only basic ICD-10 training ensure that all staff members get
Each staff member of the practice
are office managers, schedulers, this level of training is to engage the
should have, at the very least, a
and non-clinical personnel. These employees with small doses of what
basic understanding of what ICD-
individuals should be able to un- they need to know throughout the
10 entails. This role-based training
derstand what the transition is and next few months. For example, one
model can be separated into three
how it will impact the practice, as expert found that utilizing ICD-10
different levels: awareness, intense,
well as implications it may have to tidbit e-mails went a long way with
and extensive.
their own work flow. his staff in generating understand-
AWARENESS TRAINING Awareness training should start ing. It didnt take but a few minutes
All individuals in a practice setting within three months to six months to read the information provided
need at least awareness training of the date of ICD-10 implementa- each week. As a way to gauge the
regardless of their job responsibili- tion. It could be a single session retention rate of the employees,
10 | PHYSICIANS PRACTICE BROUGHT TO YOU BY PULSE SYSTEMS
 they were asked determined by each practice. Shorter lize those when applying ICD-10
to complete a training sessions for this group will codes; and
10-minute survey be better received than perhaps a full Ensuring accurate and
each month that day of learning. Make the training
compliant coding with ICD-10
related to the in- relevant to these individuals specifi-
codes on claims.
formation that was cally. The list below contains main
previously received points that should be communicated ICD-10 training should begin as
and reviewed. If during this training. soon as the employees have been
retention problems Fundamentals of ICD-10; assessed. Detailed education in the
were noted, the
Differences between ICD-9 and new code set should have already
expert could go
ICD-10; and started within the six months lead-
back to a certain
topic and go more Code structure and conventions ing up to the ICD-10 transition,
in depth with the review. for these staff members to become
training. Another These individuals should be experts. Weekly practice on real
expert decided trained at least six months to nine cases ensures that the coding staff
that a 15-minute months prior to Oct. 1, 2015. Some will be able to correctly assign the
presentation at bi- of the areas will need to be re- appropriate claims to the bill at
weekly staff meet- viewed again at different intervals in ICD-10 implementation, which
ings was the route order to retain the information and decreases the chances of any delay
for awareness changes between the two code sets. in payment. These practice exer-
training of those cises should include both code sets.
EXTENSIVE TRAINING
employees. Verbal This is referred to as dual coding in
Any practice employee whose role
communication of which both the ICD-9 and ICD-10
includes assigning ICD-9 codes
these key areas was diagnosis codes are assigned for
for ordering tests, reimbursement,
used to ensure the
or quality initiatives will need internal education purposes.
individual under-
to undergo an extensive ICD-10
stood these aspects TRAINING SOLUTIONS
training process. A gap analysis of
of ICD-10. CMS, the AMA, and AHIMA of-
these individuals will provide the
INTENSE TRAINING current skill level and what each of fer free and paid resources for the
Intense training them will need to obtain ICD-10 transition and implementation of
will be needed for proficiency. Additionally, this cat- ICD-10. CMSs Road to 10 is
providers, clini- egory of learners should be assessed a library of free online resources
cians, ancillary before ICD-10 training is started to for providers of small practices.
staff, quality man- find out which individuals should The AMA provides informative
agers, and compli- brush up on their skills in anatomy resources for its members but has a
ance officers; the and physiology or pathophysiology, section of free downloadable items
majority of those as needed. The American Health for nonmembers. AHIMA provides
at a practice. The Information Management Asso- a multitude of free resources to
following are some ciation (AHIMA) estimates that nonmembers as well as a members
roles that fall into approximately 16 hours of hands-
only area. One single solution
the intense training on coding training in ICD-10 will
category: physi- will not work for every physician
be needed in order for an individual
cians, PAs, NPs, practice. It is imperative to quickly
to learn the new code set. These
registered nurses, employees must be trained on all figure out which solution works for
licensed practical nurses, medical aspects of coding with ICD-10. each practice. n
assistants, imaging or laboratory Those include the areas listed in
managers, and individuals who are the awareness and intense training Angie Comfort, RHIA,
responsible for the quality man- categories as well as the following: CDIP, CCS, is a senior
agement and compliance for the director of health
Working foundational knowledge
practice. information manage-
of the biomedical sciences;
Employees that need intense ment practice excel-
training should experience the same Understanding how to utilize all
resources available to ensure con- lence at AHIMA. E-mail her at
training for ICD-10 awareness but
tinued accuracy of coded data; angie.comfort@ahima.org.
would additionally need to have tar-
geted training based on the practices Identifying the differences be- 2015 American Health Infor-
top 20 billed diagnosis codes. The tween ICD-9 and ICD-10 coding mation Management Association
exact number of diagnoses would be guidelines, and being able to uti- (AHIMA). Reprinted by permission.
BROUGHT TO YOU BY PULSE SYSTEMS PHYSICIANS PRACTICE | 11
 QUESTIONS TO ASK
YOUR VENDORS
We want your practice to understand what ICD-10 means for your
specific specialty. Pulse Systems has prepared this list of questions to
ask your Electronic Health Records (EHR) and Practice Management
(PM) vendors to assess your readiness, and provided our own answers
as a benchmark for what you should expect:
BY GREG VAP All of Pulses ICD-10 compliant 6. When can I begin
EHR and PM software will operate
testing your ICD-10
1. What date will you be on the same platform and database
which was used for ICD-9. compliant EHR and
ready for ICD-10?
PM systems?
Pulse already has its ICD-10 system
Pulse clients have been able to
in place with our EHR and PM
systems. This functionality was
Pulse was the test our ICD-10 compliant EHR
tested and completed in early 2015. first healthcare and PM systems since Q2 2015.

2. When will you be able information 7. When will your ICD-10

to show me how ICD-10 technology compliant EHR and PM
will work in my EHR and (HIT) company be released to me?
PM Systems? to demonstrate Pulse clients have already up-
Pulse was the first healthcare
information technology (HIT)
what ICD-10 graded to the ICD-10 solution.

company to demonstrate what
ICD-10 looks like and how it
functions in real EHR and PM
software solutions. Pulse launched
its ICD-10 Complete EHR and
PM demonstration at the MGMA
tradeshow on Oct. 6, 2013.
3. Will your EHR and
PM solutions be able to
fully support ICD-10?
Yes, all of Pulses fully-integrated
EHR and PM systems are already
compliant well before the deadline.
4. Is your software
going to run on the
same platform and data-
base that we are cur-
rently using or is a new
one going to be used?
12 PHYSICIANS PRACTICE BROUGHT TO YOU BY PULSE SYSTEMS
looks like and
how it functions
in real EHR and
PM software
solutions.
5. Am I going to be able
to use the same tem-
plates and content that
I currently have or will
I need to re-customize
them for all the new ICD-
10 compliant software?
Pulse clients can use their
existing templates and content.
There is no need to re-customize
templates for Pulses ICD-10
compliant software.
8. Will your EHR and
PM systems support
both ICD-9 and
ICD-10 codes?
Yes, Pulse EHR and PM systems
support ICD-9 and ICD-10
codes, both now and beyond
the compliancy date. This is
important because dual com-
patibility of ICD-10 is required
since not all insurance will be
forced to submit ICD-10 coding.
An example of this is Workers
Compensation.
 CONTENT PROVIDED BY PULSE SYSTEMS

10. Will I be able Pulse is taking well as a fully dedicated ICD-10

to search for ICD-9
and ICD-10 codes
in your ICD-10-compliant
systems?
Yes, our systems each have a
search feature which enables our
clients to search for both ICD-9
and ICD-10 codes.
11. Will you help me test
consulting service team that can
a leadership role help prepare your practice.
in de-mystifying 15. Will support for
ICD-10 for our my current products
current and future be discontinued after
clients. Pulse wants Oct. 1, 2015?
our clients to focus No, Pulse supports all of our
current and upgraded software
on the transition, solutions.

my ICD-10-compliant not the hype. 16. Do you know when

EHR and PM system
with the payers?
Yes, Pulse has already tested its
ICD-10 compliance and accuracy
with payers.
12. How much will you
charge to upgrade my ICD- provide to me and my
9 to ICD-10 solution?
Pulse clients did not have to pay practice for ICD-10?
anything extra to receive the
ICD-10 compliant version of our
EHR and PM solutions.
13. Will I need new hard-
ware to accommodate
your ICD-10 upgrade?
No, Pulse clients can use the same
hardware that operates Pulses EHR
and PM software today.
14. What tools, train-
ing and support will you
staff so we can ready our
Pulse is taking a leadership role
in de-mystifying ICD-10 for our
current and future clients. Pulse
wants our clients to focus on the
transition, not the hype. Pulse
has a series of educational tools
on www.pulseinc.com/icd-10, as
most payers will begin
accepting ICD-10 codes
for pre-authorizations
for dates of services
that will take place
after Oct. 1, 2015?
Most payors will begin accepting
ICD-10 codes for all pre-authori-
zations with dates of service Oct.
1, 2015 or later, beginning June
1, 2015.
Greg Vap, SVP,
Strategic Planning
and Business
Development,
Pulse Systems Inc.

PULSE CAN PROVIDE REVENUE

CYCLE MANAGEMENT SOLUTIONS
Pulse RCM Services ease the burden of ICD-10 coding mishaps by supporting the financial
functions of your medical practice with experienced, results focused, certified coders and
billing and collections experts, who are based right here in the U.S. Pulses RCM Service
is the perfect solution for a medical practice that wants to focus completely on delivering
quality healthcare to their patients.

Many RCM vendors wont work a claim past the point of a denial, sending the work back
to the practice. Our full scope revenue services covers claim denials and coding mishaps,
cutting your in-house administrative costs. At Pulse, we dont stop working on a claim until
you get paid. We collect our service fee as a percentage of the money you makenothing
more, nothing less. You wont find hidden fees or increased costs in our contracts.

To learn more, call 800.444.0882 x3 or visit www.pulseinc.com.

BROUGHT TO YOU BY PULSE SYSTEMS PHYSICIANS PRACTICE 13

PHYSICIAN
EDUCATION
FOR ICD-10
As Oct. 1 approaches, get your physicians ready by determining
how much and what kind of ICD-10 training theyll need.
BY MELANIE ENDICOTT, MBA/HCM

With only three months to go until

the implementation of ICD-10, the
countdown is on for physicians,
and other clinicians to be educated
on the nuances of this new code set.
BREADTH AND DEPTH OF TRAINING
Training in ICD-10 is being offered
by many different companies in
multiple formats, such as online
learning, face-to-face workshops,
textbooks, or webinars. With all of
these different options, the first step
is for the physician to determine the
depth of ICD-10 training needed. A
few questions to ask:
Will the physician be assigning
codes in ICD-10?
Does the physician have coding
staff to assign the codes, but needs
to be educated on the documenta-
tion requirements for ICD-10?
Are there other clinicians in the
practice, such as nurses, therapists,
etc., that need training on ICD-10
documentation requirements?
Depending on the work flow of
the practice, the physician may or
may not be responsible for selecting
the diagnosis code(s). If the physi-
cian is selecting the ICD-10 code,
either on a superbill or within an
EHR, a detailed course/training
to the addition of laterality, which physician may want a more com-
covering guidelines and conventions
is hopefully already being docu- prehensive training covering all
of ICD-10 may be in order. How-
mented. Clinicians who currently body systems.
ever, if the physician has coding staff
have high-quality documentation
that assign the diagnosis codes based TRAINING MODALITIES
on the documentation, the focus of will likely experience a very smooth
After determining the depth and
training should be on the nuances of transition to ICD-10, with minimal
documentation changes necessary. breadth of ICD-10 training de-
documentation for ICD-10.
Another factor to consider is the sired, the next step is to look at the
The ICD-10 classification system
breadth of training. For instance, delivery mechanism. There is not a
includes many more codes than
ICD-9, which at first may be daunt- a cardiologist may only be inter- one-size-fits-all ICD-10 physician
ing to the clinician. However, when ested in learning about diagnosis training program. Comparing and
taking a closer look, much of the codes pertaining to the cardiology contrasting the different types may
expansion of the code set is due specialty, whereas a family-practice assist in selecting the best option.
14 | PHYSICIANS PRACTICE BROUGHT TO YOU BY PULSE SYSTEMS
 FACE-TO-FACE for the time-strapped healthcare ideal for that clinician wanting to
Attending a professional. Webinars are great for preview the codes and get a feel for
workshop or hir- learners who like to both see and the necessary documentation. If the
ing an expert to hear the material being presented. physician is working in a practice
do the training that has coders assign the codes,
is probably the TEXTBOOKS
Probably the least expensive option then the physician should work to-
quickest method; gether with the coder to ensure that
however, it could for training is to purchase a textbook
from a reputable ICD-10 the documentation in the record is
be the most costly.
training company. Be sure specific enough for accurate ICD-
Many companies
to review the content of 10 code assignment. Ideally, physi-
and individuals
cians and coding staff should work
offer training in
together to ensure that the
ICD-10, and some
tailor it to specific documentation is ready
needs, such as phy- for Oct. 1, 2015.
sician documenta- NEXT STEPS
tion requirements. A physician
Having an expert If the physician is working in practice that has
come to the
practice to do the a practice that has coders assign implemented an
ICD-10 commu-
training allows
for individual-
the codes, then the physician should nication plan,
developed a
ized, practice- work together with the coder to ensure budget, complet-
specific training.
One valuable that the documentation in the record ed staff educa-
tion, performed
exercise would be is specific enough for accurate readiness testing,
to have the expert
trainer review the ICD-10 code assignment. analyzed docu-
current clinician mentation, reviewed
documentation quality reporting re-
and identify gaps quirements, and is work-
in documentation ing on physician education
that need to be on ICD-10, is on a positive
remedied for ICD- pathway to implementation. Oct.
10 readiness. This the textbook to determine if it is 1, 2015 is quickly approaching and
exercise of docu- geared toward coders or clinicians. time must be used wisely. n
mentation analysis A textbook for coders may be too
could even be done granular for the average clinician who Melanie A. Endicott, MBA/HCM,
by an internal cod- needs assistance with documentation RHIA, CDIP, CCS, CCS-P, FA-
ing staff member requirements, not coding guidelines. HIMA is a senior director of health
that has received information management practice
PUTTING TRAINING INTO PRACTICE
extensive ICD-10 excellence at AHIMA. Email her at
Once the training is complete,
coding training. melanie.endicott@ahima.org.
the physician must practice what
ONLINE was learned. Many EHR vendors 2015 American Health Infor-
The flexibility of taking courses are offering the option to practice mation Management Association
online is attractive to many and the coding in ICD-10, which might be (AHIMA). Reprinted by permission.
cost is typically lower than a face-
to-face training. Busy clinicians may
prefer to take an online course at
their leisure, as time allows. Howev- RESOURCES
er, finding an online course to meet AHIMA ICD-10-CM/PCS Implementation Toolkit
a practices individual documenta-
tion needs may be a challenge. AHIMA ICD-10 for Physicians and Clinicians
WEBINARS
AHIMA 2015 ICD-10-CM Coder Training Manual
Another form of training that
doesnt require travel is webinars. AMA ICD-10 Resource Center
Oftentimes, these webinars are
recorded and may be viewed at any CMS Provider Resources: Road to 10
time, allowing for great flexibility
BROUGHT TO YOU BY PULSE SYSTEMS PHYSICIANS PRACTICE | 15
 Pulse RCM
D e l i v e r i n g t h e r i g h t e x p e r t i s e t o

BILLING & COLLECTIONS SERVICES

Denials
Follow up And reSolVe clAiM deniAlS to
the AppeAl leVel

Coding
cpc coderS reView And code
encounterS For AccurAcy

Payment Posting
poSt MAnuAl And electronic pAyMentS
or AdJuStMentS per the eoB

Charge Entry
dAily entry oF All chArGeS

Reporting
BoArdrooM reAdy FlASh reportS
proVided Monthly

Completely thorough, completely transparent. At Pulse, we care for your practice as if it were
our own. Our U.S. based Revenue Cycle Management Team focuses on the financial functions
of your practice, so you can focus on delivering quality healthcare. Some medical
practices have reduced their days in A/R by 30% by switching to Pulse RCM Services.
Call us at 1.800.444.0882 x3 or visit www.pulseinc.com.

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