Is Your EMR Ready for ICD-10?

It’s only a matter of time before the leaves start changing and the pumpkin spice lattes start flowing—and that means the October 1 transition to ICD-10 is just around the corner. But rather than kicking their preparations into high gear, many providers are kicking back and relaxing—because their EMRs already have everything handled, right? Right? Anyone? Bueller?

Unfortunately, not all EMRs are created equally—and not all are equally prepared for the impending ICD-10 transition. So, how do you make sure your system is in fighting shape for ICD-10? For starters, nail down the answers to the following questions:

1. Does your EMR prompt you to document specific details of the patient’s injury or condition?

One of the biggest reasons the medical community is transitioning away from ICD-9 is that the old code set doesn’t allow providers to accurately—and specifically—represent patient diagnoses through the use of diagnosis codes. And to encourage—er, force—healthcare professionals to move away from the now-common practice of submitting generalized or unspecified diagnosis codes, payers will require a high level of coding specificity as a condition of payment. As this HIMSS page explains, “With the expansion of diagnosis codes comes a greater level of detail; therefore a greater level of detail will be required in the encounter documentation in order to assign an appropriate diagnosis code.”

Of course, detailed diagnosis coding goes hand-in-hand with detailed documentation—especially if the clinician (e.g., the physical therapist) isn’t the one submitting claims. How is a biller or coder supposed to select and/or verify a diagnosis code if the supporting documentation isn’t detailed enough to inform that choice? Unless your practice’s coder moonlights as a psychic, he or she won’t be able to pull that one off—at least not 100% of the time. So, if you want to receive 100% of your payments—and I’m no psychic, but I’m betting that you do—you better cross all your t’s and dot all your i’s within your documentation, and make sure your EMR allows you to do so, too.

2. Does your EMR’s code selector prompt you to choose more specific codes when greater specificity exists?

Maybe you’ve already called up your EMR vendor and asked whether the system has—or will have—an ICD-10 code selection tool. (If you haven’t, stop what you’re doing and pick up the phone. I’ll wait right here.)

Okay, let’s assume your vendor has assured you that the system absolutely, positively will have functionality that allows you to select and document ICD-10 codes. That’s fantastic—but your investigative work shouldn’t stop there. Sure, your EMR might have all the applicable codes loaded into its system—and you might even be able to search for the right code by diagnosis or anatomic site. But just because you can find codes doesn’t necessarily mean you’ll find the right ones, especially when specificity comes into play.

For example, let’s say you’re searching for a code to express the diagnosis of patellar tendinitis. The code M76.50 (Patellar tendinitis, unspecified knee) might appear at the top of your search results, but it doesn’t account for one very important diagnostic detail: laterality. However, if your EMR prompts you to code for laterality when that specificity exists, then you’ll land on either M76.51 (Patellar tendinitis, right knee) or M76.52 (Patellar tendinitis, left knee). And by using a more specific code, you’ll greatly decrease your chances of receiving a claim denial.

3. Did your EMR base its ICD-10 code library on GEMs?

Despite this acronym’s sparkly association, there’s nothing precious about GEMs—a.k.a. general equivalence mappings. As this blog post explains, “…GEMs were never intended to serve as single-code translation dictionaries. Because of the way they’re structured—in clusters of two to four related codes—GEMs may map one ICD-9 code to several ICD-10 codes and vice-versa.” While GEMs can be useful for converting large batches of data, they’re not reliable mechanisms of one-to-one code translation. So, if your EMR simply used GEMs to map each of its existing ICD-9 codes to an ICD-10 substitute, then you could be in for a rude awakening come October.

4. Does your EMR claim to have an automatic crosswalk from ICD-9?

Like an ill-prepared college student desperately searching for a cheat sheet the night before the big test, healthcare professionals who have put off their ICD-10 prep work until the eleventh hour are desperately searching for a magic bullet that’ll make all their ICD-10 worries fade into oblivion. Some EMR vendors have capitalized on that desperation by claiming to offer solutions that automate the ICD-10 code selection process or produce accurate ICD-10 matches for all of the ICD-9 codes you know and love. The problem is, no such tool exists—at least not one that actually works. Why? Because, as this blog post points out, “…when it comes to translating ICD-9 codes into the language of ICD-10, there’s no technology sophisticated enough to do the thinking for you.” Furthermore, “the new code set wouldn’t function the way it’s supposed to without the human decision-making factor.”

5. Will your EMR allow you to practice coding with ICD-10 prior to October 1?

As the old saying goes, practice makes perfect. Attempting to code in ICD-10 with zero practice would be like showing up to run a marathon with zero training mileage under your belt. And with payment at stake, this definitely isn’t the time to wing it. The same goes for your coding tools: If your first time using your EMR’s ICD-10 functionality is October 1, 2015, then you could be fighting an uphill battle fraught with frustration, claims backup, and workflow disruption. So, make sure your EMR will release its ICD-10 coding tool before the go-live date. That way, you and your staff can train in a relaxed, no-pressure environment. Plus, you’ll be able to run internal testing programs and participate in external testing opportunities.

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Technology will play a huge role in the transition to ICD-10, and if you arm yourself with the right tools, you can greatly ease the shock of the shift. But while Ferris Bueller seemingly can navigate any sticky situation relying on wit and charm alone, no amount of charisma can make up for an EMR with a sub-par ICD-10 solution. So, before you put your feet up and enjoy the last of the summer sunshine before the fall chill sets in, make sure your EMR is truly ready for October 1.


Why You Shouldn’t Stick It Out with Your Software

Are you unhappy with your current EMR? If so, you’re not alone. Every year, thousands of rehab therapy professionals suffer through clunky documentation processes, delayed reimbursements, and manual—which means time- and resource-consuming—updates (cue saccharine Sarah McLachlan song). But it doesn’t have to be like that. For as little as a few dollars a day, you can rescue a rehab therapy professional from the cruelty of antiquated and dysfunctional EMRs.

Okay, so maybe the current EMR market doesn’t quite call for an ASPCA-esque commercial, but for rehab therapy professionals who deal with ill-designed EMRs every day, the struggle is very real. According to a 2013 report from Orem, Utah-based research firm KLAS, private practice providers “are leaving their vendors at an unprecedented rate as EMR solutions fail to meet rising expectations in small physician practices.” The report found that providers are experiencing bad service, product gaps, poor usability, and other limitations that come in like a wrecking ball and destroy clinic productivity, employee satisfaction, and revenue.

If you’re a professional grappling with EMR dissatisfaction, your current system’s résumé probably reads like this:

  • server-based
  • designed for physicians
  • charges per chart or visit
  • lacks free training and support

While those aren’t the only reasons for switching, they are four of the biggest EMR pitfalls—and the cause of many a headache for rehab therapy professional everywhere. If you think you can’t ditch that crappy EMR because it’s too difficult or too expensive to switch, you’re wrong. In fact, staying with an EMR that doesn’t work for you could end up costing you more. Here’s how:

Weighty Consequences

Server-based EMRs are obese clunkers full of ancient technology. In the age of all things mobile, you deserve an EMR you can take with you—anywhere, anytime—but you can’t exactly fit a server in your pocket. Server-based systems take up a large chunk of space—and take a large chunk out of your wallet. If you’ve had your EMR for years, you’ve already written off the cost, so having to shell out for a new system—especially a web-based system, which comes with a low initial investment—shouldn’t be too much of a concern. However, if you’ve recently adopted a server-based EMR, I can understand your hesitation to switch—but think about how much that system is costing you in time and productivity.

If you have a server-based system, the responsibility of securing your patients’ protected health information (PHI) and performing all the upgrades is solely on your shoulders—and that’s no easy task, especially if you aren’t technologically inclined (you may even have to hire IT staff to maintain your system, which makes server-based systems even pricier). Plus, if you miss an update, your system immediately becomes out-of-date, putting you at risk for non-compliance—and considering the speed at which regulations change, that could end up being very costly (I’m talking penalties, fees, rejected claims, and audits). Web-based systems, on the other hand, offer you the security, accessibility, compliance, and data management you need.

Weak Flow

You wouldn’t stay in a relationship with a person who didn’t “get you,” right? So why stay with an EMR that doesn’t understand you, your industry, or your workflow? EMRs designed for physicians—not physical therapists—tend to offer workflows that don’t make sense for your needs, forcing you to spend far too much of your precious time trying to mold the system to fit a PT’s workflow. Wouldn’t you rather get back to treating patients instead of working around problems that shouldn’t even be there? If your EMR lacks key features like built-in functional limitation reporting, 8-minute rule monitoring, and therapy cap tracking, you need to switch to one that cares as much about your practice as you do.

$pendy $upport

If your EMR doesn’t offer you free training and support, you’re going to wind up spending way more than the sticker price to successfully implement and operate your new system (if that’s even possible to begin with). You’re already paying for the software; if you need help along the way, you shouldn’t have to pick up the tab for that, too. Straightforward, flexible, and free phone support and training—from the get-go—should be part of the package, and any EMR company worth its salt will agree with me on that point.

And speaking of unnecessary fees: Does your EMR charge you per chart or per visit? Well, it shouldn’t, because that means you’re penalized for expanding your business. Who wants to be punished for success? (Psst: the answer is no one). When you make the switch, be sure to choose an EMR that charges per user and offers a subscription model. Oh, and one more thing: Beware of “Jack-of-All-Trades” software companies that give away certain aspects of their software (e.g., their documentation or scheduling platforms) in an effort to lock you into their more lucrative components (e.g., revenue cycle management).

 

If you’re having documentation problems, I feel for you. Because even if you have 99 other problems at your clinic, your EMR shouldn’t be one of them. It’s simply not worth holding onto a system that doesn’t function or follow through on promises. And right now—fewer than seven months away from the mandatory transition to ICD-10—may just be the best time to switch if your current EMR vendor isn’t prepared for the transition.

To help you achieve greatness in practice, you need an EMR that is accountable, efficient, cost-effective, accessible, secure, and most importantly, compliant. Trust me, you’re not going to get that with anything but a truly web-based EMR designed with the PT in mind. Don’t settle for less than what you need—and deserve.


Give Yourself the Gift of EMR

The traditional gift-giving holidays are all behind us now—even Cupid has holstered his bow and arrow—but that doesn’t mean you can’t treat yourself to something really nice just because. Give yourself the gift of EMR this spring, and say goodbye to writing, filing, and lugging paper charts—a pain, whatever the season. And that’s not all. With the right EMR, you’ll get these other great gifts that just keep on giving, too:

Legible, Accessible, and Defensible Documentation

All physicians must transition to EMR by 2014, and there’s a reason for that: compared to paper charting, EMRs are better able to provide the medical community as a whole with legible, accessible, and defensible documentation. And that’s important for both patients and providers, especially as we continue to move further into this pay-for-performance, regulation-heavy healthcare environment. With an EMR, your documentation will better tell your and your patients’ stories. And you’ll never again have to sort through another towering stack of filing cabinets in search of a certain note, only to find that you can no longer read the chicken scratch that once passed for handwriting.

A Partner in Compliance

Each reporting regulation has its own unique—and often messy—set of requirements, but with the right EMR,  you’ve got a partner in compliance. Instead of stressing about all the hard-to-keep-straight details—like those for PQRS, functional limitation reporting, the 8-minute rule, and the therapy cap—you need only follow the built-in prompts and alerts to complete the requirements for the right patients, every time. Plus, your EMR can help you manage the transition to ICD-10.

Unmatched Safety and Security

Choose a cloud-based EMR, and your patient data will be safe and secure—always. You’ll have all the perks of the world’s leading data centers—like protection from natural disasters, digital video surveillance, biometric screening, and round-the-clock guards—and none of the cost or responsibility.

A Leg-Up on the Competition

For most physical therapists, referrals make up a large part of new business. With an EMR, you can maximize those referrals by tracking how many you receive and from whom. It’s a great way to identify those in your network who need a little more attention and those who deserve a big “thank you.” With an EMR, you can also display your clinic’s logo on all of your digital documents, so every note you send is a reminder to prospective referrers of your skills and professionalism. Talk about a big leg-up.

Now’s the perfect time to nix perilous paper—think of it as an extension of your annual spring cleaning—and make 2014 a year to remember with the best gift you, your clinic, and all the trees of the world could ask for: EMR.


4 Reasons Why You’ll Need an EMR for ICD-10

With the switch to ICD-10 looming on the horizon, many healthcare providers are searching for a catch-all solution to ensure a smooth, snag-free transition. As this article points out, while there’s really no “magic bullet” for ICD-10, adopting an electronic medical record (EMR) will definitely help ease some of the pain associated with implementing this new diagnosis code set. In fact, the thought of tackling ICD-10 without an EMR is close to inconceivable. Here’s why:

1. It will be your life preserver in a sea of new codes. If you’re overwhelmed by the sheer number of codes included in ICD-10, you’re not alone. To give you an idea of the scope, there are more than 68,000 ICD-10 diagnosis codes and 72,000 procedural codes. For comparison, ICD-9 has 13,000 diagnosis codes and 4,000 procedural ones. Add to that a complete overhaul of the actual code structure—ICD-10 codes contain up to seven characters, whereas ICD-9 codes only contain up to five—and you’ve got a recipe for a serious panic attack. But if you have the right EMR, you can breathe easy—or at least easier. Good EMRs feature built-in intelligence to help you select diagnosis codes based on the information you’ve recorded in your documentation. That way, you don’t have to thumb through hundreds and hundreds of pages of diagnosis codes to find the one you’re looking for.

2. It will ensure you code as specifically as possible. In addition to helping you find the right code for each diagnosis, an EMR also will prompt you to code to the greatest possible level of specificity. For example, as explained in this blog post, some diagnosis codes require a related external cause code to indicate the origin of a patient’s injury or condition. These codes do not exist within ICD-9, so remembering to add them might prove difficult at first—unless you have an EMR that remembers for you. And with everything else you’ve got on your plate, that peace of mind could be huge—especially considering that payers will come to expect this information to be readily available on patient claims.

3. It’s a big piece of the interoperability puzzle. In their quest to increase the efficiency and quality of patient care in all specialties, healthcare leaders all over the world have pushed for a medical landscape with fast, seamless information exchange—a.k.a. interoperability—across all healthcare platforms. The global move toward ICD-10 represents a huge part of this initiative as it allows for uniform coding of complex information, thus making the resulting data easier to share. But true interoperability cannot exist without effective communication and adequate technology—and that’s where EMR comes into the picture. In this day and age, it would be nearly impossible to achieve constant interconnectivity and communication across all healthcare providers without across-the-board implementation of secure, portable, cloud-based EMR systems.

4. It will allow you to focus on what truly matters—your patients. The magnitude of the transition to ICD-10 could easily pull your attention away from your ultimate goal of providing exceptional care to each and every patient. But with an EMR, you’ll have a partner to tackle some of the tedious code selection stuff so you’ll have the bandwidth to handle bigger-ticket tasks—like helping your patients achieve amazing outcomes through therapy.

So, before you pull your hair out over this whole ICD-10 switch, be sure your practice has all of the tools necessary to make the transition as painless as possible—chief among them: an EMR.