Luck is an unfaithful friend, especially when it comes to ICD-10

on Thursday, 14 August 2014. Posted in goPMO Corporate

If you have heard the words "with luck" or "hopefully" or "not sure if we are ready" in your conference rooms when discussing ICD-10 readiness, then you have most likely left to lady luck to show up on time and ready to play. As most folks are working through their Meaningful Use attestations and getting applications upgraded or replaced, 2015 will be upon us before you know it.


If you are still figuring out how to deal with ICD-10 compliance, the time for planning is over and it’s time to make your own luck with some good ole' fashion blocking and tackling. Many ambulatory doctors in particular are waiting for updates from their vendors and, as a result, many will need the extra time to test the new updates once they arrive. Here are some tips on how to make sure you reach compliance by October 2015.

Focus on the Basics

With limited time to implement the updates and testing, start with focusing on what really matters in the time you have left:

  1. Software Implementation and Testing
    ICD-9 and ICD-10 need to co-exist and run simultaneously – at least initially. While vendors struggle to switch to ICD-10 there will be some overlap between the two systems, so make sure your primary and ancillary systems can handle the new ICD-10 codes, while running out any leftover ICD-9 business.
  2. Training
    Converting to the new coding system will affect virtually every aspect of your operations. You need to develop a training plan and provide crash courses on the essential knowledge for your staff in correct ICD-10 coding. The sooner your staff can start becoming familiar with the new systems and solve any issues that may arise, the easier the transition will be. Critical training topics include documentation of patient activities, coding both medical and administrative records and contracts, as well as information technology and health plan relations. Not only is this training vital for coding staff, but also for the clinical and administrative team, as well as the Revenue Cycle Management staff:
    1. Clinical Staff Training
      Both Clinical & Admin Staff will need to be thoroughly trained to cope with the sheer number and complexity of the ICD-10 codes (68,000 diagnosis codes and 72,000 procedural codes). The ICD-10 code set is significantly more specific than the current codes in use and require additional specifications, such as causes of accident or illness, stage of healing and disease details. This means clinical staff will have to adjust their clinical documentation workflows to provide consistent accuracy. Without this information, coders will not be able to process the medical records and have to send them back to the doctor for the right code. Not only does this reduce productivity, it impacts patient care and ultimately, delays payments and affects cash flow for your organization. Physicians in particular will need not only ICD-10 training and information on the clinical concepts related to their specialty, but they will also require detailed training on clinical documentation in order to provide a comprehensive report of the patient’s condition and the services provided, allowing the coder to assign the appropriate ICD-10 code.
    2. Revenue Cycle Management Training
      Whilst the transition to ICD-10 offers the potential for significant performance improvement, revenue cycle management will need particular attention, since it involves critical systems, including medical coding, billing, reimbursement and contract management. Medical coders will require training at a high level to ensure the medical records are coded correctly but it will also be critical to establish whether the existing code set effectively represents the policies and goals of the health system, and to define whether there is a chance to leverage the clinical specificity and granular coding potential in order to optimize processes and reflect more precisely the services provided, thereby maximizing revenue for the organization.
  3. Integration
    To ensure continuity and productivity, you need to get your trading partners on board with you, particularly the insurance carriers. Providers, vendors and payers all need to synchronize and streamline their efforts and be communicating to you as their partner, on their readiness as the deadline closes in.

Improvement Initiatives

Once you have these pieces in place, then you are positioned to perform a little clean up and launch improvement initiatives:

  • Implement computer assisted coding automation
    Computer assisted coding (CAC) software uses information from clinical documentation and assigns an ICD-9 or ICD-10 code to the data. The software uses natural language processing (NLP) to analyze notations in a patient’s chart and determine which notations are related to a diagnosis, and select the appropriate code, or group of codes. CAC software provides an automated process that gives you faster coding while maintaining, or improving, the accuracy level.
  • Dual Coding Comparative Analytics and Key Performance Indicators
    Dual coding is widely defined as natively assigning both ICD-9-CM and ICD-10-PCS codes to a patient record during the same coding session, and is an effective way to obtain accurate data. The reimbursement schedules vary between ICD-9 and ICD-10, with ICD-10 allowing for a more refined reimbursement model which presents opportunities for optimal claim reimbursement based on the more specific ICD-10 code, over the broader ICD-9 code. In order to predict how the organization will be impacted financially by reimbursement changes, proactive and parallel analytics will be required to compare the historical billing amounts for procedures to the new ICD-10 payments. By updating existing processes, you will be able to identify and then forecast reimbursement payments and investigate any variances shown between ICD-9 and ICD-10 revenue.
  • Refined Training Programs
    Your staff are loyal and a critical part of the implementation process. Train and retrain your staff and they will become highly valuable to you. Make sure you have enough cash flow to cover their payroll post implementation – you don’t want to lose them!
  • Get Specialized Help
    Healthcare organizations will face numerous challenges during the ICD-10 implementation and testing over the coming months. To get the support you need, seek out an external specialist vendor who can assist with:
    • Troubled project remediation
    • Training
    • Application upgrades assistance
    • Portfolio of applications
    • Vendor and in-house IT team coordination to test and deploy
    • Integrated testing and automated testing services
    • Reporting and data analytics

Healthcare Delivery Specialists, goPMO, are experienced in the efficient delivery of healthcare IT projects and they can provide the external support you need to effectively overcome the challenges an ICD-10 implementation presents. From defining strategic clinical and business objectives or priorities to support to get it done, goPMO delivery teams ensure that your projects are successfully deployed.

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