Client Assessment Survey for ICD-10 Readiness
Practice Name:
Practice Phone Number:
Practice email address:
How many providers are within your practice?
What specialty (ies) does your practice offer?
Where are you in your ICD-10 planning process? (Check all that apply)
Check all that apply
Not started
Planning
Budgeting
Refining documents
Asuditing chart
Training
Contacting vendors
Who are you relying on for support for ICD-10 Readiness?
Have you selected an ICD-10 point person?
Check all that apply
Yes
No
If yes, who is the point person?
ICD-10 requires much more specificity, does your practice document enough for ICD-10?
Check all that apply
Yes
No
Not sure
Currently changing documents
Do you plan to audit charts to verify for ICD-10 Readiness?
Check all that apply
Self-audit
3rd Party Service
Not planning to audit charts
Would you be interested in an audit chart assessment service?
Yes
No
Maybe
Did you contact your clearinghouse for the ICD-10 process?
Yes
No
Unclear what to ask
Did you contact your software vendors for process and/or cost?
Yes
No
Unclear what to ask
Did you contact your biller for process and/or software cost?
Yes
No
Unclear what to ask
Who does your billing?
Staff
Provider
Internal biller
Out-sourced
Is your biller a certified coder?
Yes
No
Not sure
Are you confident with your biller’s knowledge to code properly
in ICD-10?
Yes
No
Not sure
Which EHR/EMR and PM software do you use?
Which areas of your practice will ICD-10 have an impact on? Check all that apply.
Progress notes, Templates and EHR Picklists
Problem List Assessment
Order Entry
Authorizations
Referrals
Federal State and Local Registries
Practice Reports
Claims Submission and Claims Denial Management
Super-bill/Encounter forms
Coding Tools and Reference Materials
Would you like to talk with a Meaningful Use Experts consultant about our ICD-10 Readiness services?
Yes
No