Go live is just the beginning: Preparing for life after ICD-10 implementation

We've entered the ICD-10 homestretch, the few short weeks before health care stakeholders finally see the implementation of a transformative change nearly twenty years in the making.

But go-live is just the beginning... Even with all the preparation, there are likely to be challenges organizations need to consider after the transition. Post-implementation, not only are the potential impacts that could disrupt the transition to ICD-10 important to consider, but they also provide multiple opportunities to assess and improve operations. They include:

  • Operational disruptions: Implementation could trigger a decrease in coder productivity, backlogs in coding and billing, a fluctuation in performance metrics and resource strain on clinical documentation programs.
  • Financial impact: Potential net revenue decreases to cash flow interruptions, and an increase in denials and underpayments. Additionally, understanding root cause of potential case mix and financial shifts will be critical.
  • Resource considerations: Change management processes, evolving training needs, questions of employee retention and resource reallocation may also present challenges.
  • Technological complexities and demands: Providers may experience data transmission issues causing a need for re-testing of critical functions and unscheduled vendor updates to ICD-10 software packages.

Addressing these impacts head-on will require organizations to understand the highest areas of risk to proactively allocate time and resources. And it's not just providers – their payers, vendors and trading partners all should be equally supportive in order to alleviate financial and operational disruption.

Here are some suggestions that may address your post-go-live impacts:

Assess demands on resources: Assessing training gaps, employee morale and effective allocation of the most impacted resources will support early identification of issues with your most valued asset – your team.

Prioritize DNFC (Discharge Not Final Coded): Post-ICD-10, coding expertise will likely be in short supply and potential negative impacts on coder productivity could create a perfect storm for increased DNFC. Identify strategies with positive productivity impact, low financial and quality risk, and minimized levels of effort to keep DNFC under control. Examples include overtime opportunities for high performing coders, optimized work queues, and management dashboards that track DNFC as real time as possible.

Monitor net revenue and cash trends: Model and focus on key financial metrics such as DRG shifts, CMI changes, claim rejections (i.e., edits), increases in time-to-pay by payers, payment variances (i.e., underpayments), increased denials, and impacts to A/R to track trends in reimbursement.

Assess documentation quality: Providers may still be wrestling with the new documentation specificity and granularity requirements, as well as using diagnostic terminology rather than clinical indicators. Formally reviewing documentation through a Clinical Documentation Excellence program is the most efficient and effective way to assess documentation quality, while also providing feedback loops to physicians through formal and informal educational channels.

Audit coding productivity and quality: Coders may still be trying to fully integrate new coding concepts into their work, especially with the procedure codes, which could impact both their productivity and their accuracy. Formally reviewing coder work through standardized key performance indicators around productivity and quality, and taking immediate corrective action by conducting additional training and stand-and-deliver educations sessions, as needed, could stem issues with productivity, quality and accuracy.

Develop a formal post-ICD-10 education program: Physicians, coders and clinical documentation specialists will be some of the most highly impacted stakeholders in this transition. Putting their pre-go-live training into practice may reveal gaps in their content knowledge and will require a robust, continuing education program designed to support their educational needs proactively, before quality issues arise.

Identify reporting and data integrity challenges: To achieve meaningful reporting and analysis using ICD coding (e.g., trend analysis, quality scoring, population management), data integrity across the transition is necessary. Modeling the state of the business and identifying how ICD-coded data is currently used in key reports and analyses that drive clinical, financial and other decisions could reveal the options for handling the blended data during the conversion.

Assess your EHR template design: Updating the Electronic Health Record template to capture necessary information to support ICD-10 documentation requirements is an automated method that may positively impact quality and reimbursement.

Life after go-live:
The challenges brought on by the transition to ICD-10 may seem daunting. But a carefully designed post-go-live strategy can mitigate some of the potential difficulties by effectively addressing not only the potential go-live challenges posed by ICD-10, but also how to adapt to the period of transition immediately afterward.

Christine Armstrong, RHIA, MBA, is a Principal at Deloitte Consulting LLP with more than 25 years of healthcare experience. She has let numerous multi-system engagements, including operations improvement, productivity, revenue cycle, supply chain, information technology implementation and redesign, charge capture and CDM assessments. Christine has extensive international experience with operational improvement projects, including ICD-10 coding quality improvement and training projects.

Christi Skalka is a Senior Manager in the Life Sciences and Health Care Practice of Deloitte Consulting LLP. She has more than 20 years of experience in both industry and consulting in the areas of revenue cycle, pricing, operational improvement, and cost reduction. Her management consulting experience includes end-to-end Revenue Cycle Transformations, ICD-10 implementation and remediation, and Middle Revenue Cycle assessments and implementations, including charge capture/CDM, HIM operations, and pricing strategy and execution, specifically for large, national healthcare organizations and physician practices.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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