Coding Crunch: 7 ICD-10 Lessons From Cedars-Sinai

In 2011, Cedars-Sinai Medical Center in Los Angeles did what many providers were hesitant to do: It decided to tackle ICD-10 as an inevitable change and began its work to transition to the new system.

By contrast, only about 20 percent of providers believe they will complete or expect to complete all ICD-10 business changes by the third quarter of 2014 — the quarter before ICD-10 goes live, according to a survey from the Workgroup for Electronic Data Interchange.

Thea Campbell, director of health information and ICD-10 coordinator at Cedars-Sinai, said senior leaders saw the need to conduct a risk analysis and determine how ICD-10 would ultimately affect the academic medical center.

Cedars-Sinai executives expect the organization will be ready by the Oct. 1 deadline, thanks in part to the proactive planning approach. Ms. Campbell explains what she and her colleagues have learned during their ICD-10 planning process.

1. Ensure all IT systems will be ready. Electronic health records have usurped hospitals' capital resources during the past few years, and ICD-10 represents another costly IT endeavor. For Cedars-Sinai, which runs on an Epic platform, the price tag for the preparatory stages of ICD-10 will run into the millions, which is in line with cost estimates provided by various healthcare organizations. But that does not mean hospitals have any extra space to afford it.

Ms. Campbell says hospitals have to spend the capital to ensure all IT systems are in sync. ICD-10 will be going live in October regardless if hospitals are ready, and the coding system will be the lifeline for hospitals to continue receiving reimbursements from payers.

"That's a very crucial step," Ms. Campbell says. "You can have everything done, but if you can't bill out the door to payers, you can't get paid."

2. Don't assume revenue cycle systems are the only systems that will be affected. ICD-10 is often associated with finance and revenue cycle systems. However, it will affect far more than those back office functions.

EHRs, lab systems and numerous other platforms transmit codes, and those similarly have to be updated, Ms. Campbell says.

3. Unconditionally support the coding staff. Coders are the last line of defense between a hospital claim and reimbursement, making their training paramount.

Because Cedars-Sinai planned for ICD-10 early, the organization implemented a dual coding strategy. This means that Cedars Sinai coders ensure all visits and discharges are coded in both ICD-9 and ICD-10. "The reason for two separate work streams is two-fold," Ms. Campbell says. "First, to allow our revenue cycle to progress in a normal and consistent manner in ICD-9, and secondly, it allows our trainees to focus on the needs of ICD-10 from a documentation specificity and guideline perspective."

Dual coding, on top of intense re-education of basic coding and science principles, will allow hospital coders to feel more at ease once ICD-10 goes live. In addition, it will help the hospital spot potential problems.

4. View physician education and training as one of the highest priorities. Coders are the last stop for all claims processes, but a claim isn't a claim without physician documentation.

Ed Hock, a senior director at The Advisory Board Company, says physicians are the foundational pieces of a successful ICD-10 implementation because ICD-10 is a documentation issue as much as it is a coding issue.

Ms. Campbell strongly agrees. She says Cedars-Sinai kicked off a "fairly aggressive" physician education strategy. The system has 2,100 physicians on staff, and it is holding sessions with physicians by specialty to determine what their issues and documentation concerns were.

Proactively reaching out to physicians can result in multiple benefits, Ms. Campbell says. Aside from clearer documentation and less confusion, ICD-10 gives hospitals a chance to align with other community providers who may need help along the way.

"I think administrators have a real opportunity to be educating physicians and helping physicians," Ms. Campbell says, noting that many community physicians don't have the resources to manage ICD-10 on their own. "There could be an incredible amount of goodwill, especially when a lot could be said about physician-hospital relationships."

5. Conduct comparative data analyses to find out where money will be lost and gained. Cedars-Sinai has rigorously analyzed the financial ramifications of ICD-10. This includes analyses of payer reimbursements, costly coding mistakes and service lines. Ms. Campbell says the organization will also develop pertinent indicators to monitor, like A/R days, after ICD-10 goes live.

"When you look at our book of business, we have service lines that are going to do better in the new coding method and ones that are going to do worse," Ms. Campbell says. "Fortunately for us, they balance each other out."

Even after conducting analytics, many consulting groups, as well as Ms. Campbell, urge providers to have enough cash on hand, at least three months' worth, to serve as a buffer for any hiccups. "This is a formidable task for many healthcare organizations," she says.

6. View payers as an essential partner. Major commercial payers are in the same boat as hospitals: They have limited resources, but they must be ready for ICD-10 this fall if they want their business to stay afloat.

Hospitals and payers must act as partners on ICD-10, Ms. Campbell says. Routine testing of claims will give both groups the opportunity to see how exactly claims will be adjudicated in the new system.

7. Recognize there will be resistance. Even if an ICD-10 strategic plan goes seamlessly, some stakeholders may be leery and cold of such a large change to a process that has been the same for so long.

"That's just simply change," Ms. Campbell says. "You can't forget no matter how prepared you are, there's going to be some change resistance."

More Articles on Hospitals and ICD-10:
Survey: Most Providers, Health Plans Haven't Fully Determined ICD-10 Impact
5 Notable Stories on ICD-10
Finding the Guidance: 3 Health Systems With Proactive ICD-10 Plans

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