The final countdown to ICD-10

Bonnie Cassidy_headshot
Bonnie Cassidy, MPA, RHIA, FAHIMA, FHIMSS, Senior Director of Health Information Management (HIM) Innovation, Nuance

The old saying, “The only constant thing in life is change,” has withstood the test of time for a reason: It’s true. Federal regulations and policies are forever in flux, and whether you’re steering a small physician practice or a large health organization through the upcoming ICD-10 transition, the smallest modifications can create a ripple effect that rocks the boat.

So, the one thing that we hope won’t change (again) is the ICD-10 deadline. With less than six months to go, organizations that have been hoping for a reprieve need to kick it into gear and develop a strategy to not only weather but thrive through the transition. While we may been talking and thinking about ICD-10 for years, healthcare providers who are just now able to make a focus are still in luck. The timeline may be tighter, but evaluating readiness for ICD-10 is still a critical first move. With the right resources in place, this five-step evaluation process will enable health information management (HIM) professionals to ramp up quickly and course-correct if need be:  

Test, test and re-test. Consider all the databases and systems that need to be compatible with the new ICD-10 codes. Think inputs and outputs: every channel of communication holding an ICD-9 code today, coming in or going out, will need to be tested for ICD-10 compatibility. Testing should happen after an organization decides the design of the system, (e.g. ICD-9 and ICD-10, ICD-10 only, or any other unique configuration.) It is essential to ensuring all systems are fully integrated and able to process the data properly. A thorough program evaluation will not only reveal opportunities for improvement, but will help healthcare providers create a contingency plan, which is key to ensuring there will be enough time to meet the ICD-10 deadline in the case of an unforeseen challenge. Speaking of…

A back up to the back up. Having a contingency plan built into ICD-10 transition strategies can be the make-it-or-break-it factor in organizations successfully navigating surprise changes and challenges along the way. Along with the plan, setting realistic timelines for the transition will allow providers to properly address avoidable complications before they grow into unmanageable roadblocks.  

Retraining of your coders in ICD-9 and 10. Although it takes more time and effort upfront, dual coding in ICD-9 and ICD-10 today can improve accuracy and save organizations both time and money during the transition. In addition, analyzing data, determining top diagnosis-related groups (DRGs), and performing gap analysis will help organizations better understand their patient populations and ensure that education programs are properly preparing coders for the transition. For instance, identifying the number of high impact surgical procedures in various clinical specialties and training coders on the nuances of coding in ICD-10-PCS. Invest the time and train for your coders now reduces pain points down the line.  

Make it worth their while. Working with Human Resources (HR) to create an employee retention program will help prevent attrition and assist providers in retaining their most valuable asset — employees. Ensure physician champions are in place and provide them with education materials and opportunities specific to their day-to-day roles and obligations. Change is often difficult, so fostering health information executives’ professional development and working with HR departments on retention programs will help to maintain employee satisfaction across the board during these challenging times.

Want to go the extra mile? Here are some additional proven strategies to ramp up readiness efforts beyond the five-step process, which will help providers exceed expectations over the next few months.

Take a holistic approach to clinical documentation integrity throughout the patient stay. Be the champion for clinical documentation improvement (CDI) and focus on getting the right information into the right medical record at the right time because this will have a positive impact on quality, reimbursement, and coding regardless of shifting dates.

Refine your technology. Many providers use many manual processes, like spreadsheets and sticky notes, for clarifications and queries in medical records and emails to physicians. Take this opportunity to assess workflow and plan for technology-enabled solutions for assisting medical staff and clinical documentation specialists with CDI program and coding/compliance.

Avoid “one-size-fits-all” processes. Developing the right processes is important to every organization’s ICD-10 transitional success. And not all processes are created equal depending on the workflow. Work across stakeholders and teams to know what will work in each clinical setting.

Commit to ICD-10. Yes, this is overwhelming and scary at times. But with an ICD-10 transition plan in hand, move forward with it. Update ICD-10 project plans with dates and deliverables, built for an October 1, 2015 compliance date.

We are now six months out, but whether or not there is a shift in the ICD-10 compliance date, stay positive, plan for success and always be willing to course correct. Those rules still apply, and focusing on coding improvement now is a good strategy at any time. Regardless of the challenges ahead, it is possible to navigate the constant ebb and flow of healthcare reimbursement and the ICD-10 transition.

CDI, claims testing, clinical documentation improvement, diagnosis-related groups, DRG, health information management, HIM, ICD-10-PCS, Nuance


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