ICD-10 Transition Tips for Success

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Many providers breathed a sigh of relief when HHS extended the ICD-10 implementation deadline by one year, much like a teacher pushing back an exam date after realizing students were seriously underprepared. But with just 16 months left until the big ICD-10 test in October 2014, industry experts warn providers not to procrastinate in getting coding teams up to snuff on the new system.

Just last month, a survey of 120 hospitals by Health Revenue Assurance Holdings found that half of providers had fallen behind on the CMS suggested timeline for ICD-10 implementation, and one in five small-to-midsized hospitals responded they had not begun training their staff for the change. In addition, the Workgroup for Electronic Data Interchange announced the latest ICD-10 industry readiness survey results to CMS. WEDI's assessment of industry readiness is derived from survey responses collected from close to 1,000 providers, health plans and vendors during February 2013. The WEDI Survey results indicated that about half of the providers responded that they did not know when testing would occur, and over two-fifths of provider respondents indicated they did not know when they would complete their impact assessment and business changes.

The problem may not be as widespread as the numbers suggest, but even health systems diligently readying themselves for the switch face plenty of potential snags and hang-ups along the way that could be detrimental if not corrected by next October, says Bonnie Cassidy, senior director of HIM Innovation at Nuance, a company focused on clinical understanding solutions that drive smart, efficient decisions across healthcare.

Here are some of Ms. Cassidy's tips to providers for a seamless ICD-10 transition.

Engage physicians. It's a fallacy to isolate ICD-10 preparations and training only to the coding and billing team, Cassidy says, because of the level of the specificity physicians need to provide in their clinical documentation, which is required for appropriate ICD-10 coding. The solution is not to train physicians in ICD-10 coding, she adds, but to show them the clinical documentation requirements that align with their specialty and are needed for the hospital to provide quality patient care and be successful in transitioning to ICD-10.

She advises hospitals to give "physician champions" a look behind the scenes to demonstrate the importance of clinical documentation, and how their efforts are associated with the coding and reimbursement teams. Enabling physicians to see firsthand how errors or omissions they might make can lead to snags in care and billing processes is a useful learning experience. For example, when a physician sees the hassle a coder faces under ICD-10 when a record doesn't specify whether a procedure or diagnosis pertains to a patient's left or right side — and physicians themselves will face with follow-up for clarification — the physician will learn to pay particular attention to that when he or she is dictating into the patient’s health record in the future, Ms. Cassidy says.

Mobilizing a physician champion for each clinical department can be a smart and effective way to train physicians in providing the right information into the medical record and to motivate them to perform the task with fidelity. "The best way to communicate with physicians is peer-to-peer, so there's a strong need to engage physician champions," she says. "In addition to pursuing peer-to-peer training, it's also crucial that you focus on training physicians on the codes they need to know based on their specialty. In other words, you can't throw all these new ICD-10 codes and the kitchen sink at physicians and expect them to embrace this change and hit the ground running."

Build in enough time for coding education and practice. The coding staff must be assessed regarding their actual knowledge of anatomy, physiology and the biomedical sciences. Thorough education in all of the sciences must be completed and accomplished before the coders are trained in ICD-10. Once that expertise is attained, Ms. Cassidy recommends nine months of practice time of dual coding in ICD-9 and ICD-10 to ensure staff has adequate rehearsal working with the new coding system and problems are found and corrected.

In order to enable dual coding, system integration will be required to ensure real-time access to the electronic health record and an encoder with ICD-9 and ICD-10 functionality. Many organizations are enhancing the process with the addition of computer assisted coding. All of this technology requires detailed planning and execution of the implementation.

Offer disciplined project management and oversight. Once a clinical documentation integrity committee or ICD-10 steering committee has been established, there will be multiple projects developed. These projects must all be well managed and efforts must be reported up to a project management office or to the steering committee, all depending on the depth and breadth of the projects and the size of the organization.  

One project that should currently be in process is an inventory of all of the information technology systems that currently contain an ICD-9 code. Each one of these must be assessed and a future state of design planned for regarding ICD-10. For example, will the system still be eliminated, maintained as is, maintained with ICD-9 and ICD-10 or with ICD-10 alone? This is an area that is often underestimated and not properly planned for, Ms. Cassidy says. One corporate HIM director told her his organization had identified 125 systems that contain an ICD-9 code. "You've got to have a strategy in place that not only identifies the systems containing ICD-9 codes, but also the vendor, the contracts, and an evaluation of each of those contracts in order to make sure the technology is ready for the transition to ICD-10," she says. "In many organizations, it is a major task to identify the vendors and contracts for all of these systems, and to be sure that each of these, including interfaces, will be ICD-10 ready so as to afford timely IT testing."

With so much software and bolt-on solutions for admitting, scheduling, discharging, marketing and even registries, it can be easy to overlook some that may have functionalities that rely on ICD-9 codes that will no longer be used. Ms. Cassidy says providers should not wait to find these ICD-10 incompatibilities until they depend on them for their day-to-day operations.

All of these projects require subject matter expertise and strong project management skills. Keeping tabs on how training and simulations are progressing to prevent a backlog in accounts receivable requires designated and talented managers. "You've got to get people who get up in the morning and think about project management," Ms. Cassidy says.

To fund all of these projects in a PMO, a multiyear ICD-10 budget should be put in place and must account for all of these investments in information technology, resources, consultants, outsourcing and more. Human resources must also be involved to create retention programs for your critical roles such as clinical documentation specialists and coders. With the investment made in multiple years of education and training to prepare for ICD-10, you want to retain your talent. Retention programs and bonuses may prove fruitful during what may be a tumultuous transition. Additionally, human resources must work with HIM leadership to establish coding tests and skills inventory that will be administered when hiring new coders to gauge how developed and prepared they are to assume a position as an ICD-10 coder

Provide clear, ongoing communication. Good project management includes a strong communication program. Everyone must be aware of the organization's transition to ICD-10. Even with extensive training and diligent project management, human error is bound to occur. Identification of slippage in your project plan or roadmap must be communicated to the PMO or steering committee to create contingency plans. These plans, of course, will require additional investment of time and resources.

The key to avoiding headaches, backlogs and lost revenue, Ms. Cassidy says, is proper planning, troubleshooting and adequate preparation time, which always takes longer than expected. CMS has made it very clear that the Oct. 1, 2014 compliance date stands firm so the healthcare industry should not expect any more delays. Organizations that are behind need to step up their efforts in order to be ready and successful on Oct. 1, 2014. According to Ms. Cassidy, resources like Talk Ten Tuesday and the AHIMA Body of Knowledge can help providers learn best practices to fast-track their ICD-10 transition.

More Articles on ICD-10:

UnitedHealthcare Exec: ICD-10 Will Improve Healthcare
7 Steps to Ease the Transition to ICD-10 for Physicians, Specialists and Groups
Survey Shows Providers Far Behind in ICD-10 Planning

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