The road to ICD-10 implementation is now a race

14 Jan 2015 3:46 PM | Brian Kelley
Retrieved from ICD10Watch.com   |  Jan 14, 2015   |  CARL NATALE

We need to stop calculating the odds of another ICD-10 delay and get to work. There is less than nine months to be ready for ICD-10 implementation.

According to the Centers for Medicare and Medicaid Services (CMS) Road to 10 planning tools, medical practices should be this far in the ICD-10 transition:

Planning (Should have been finished already so get on it now)
  • Create an ICD-10 team
  • Create an internal impact assessment
  • List work processes and current electronic systems that use ICD-9 codes. The AMA suggests looking at:
    • Claims submission
    • Billing system
    • Posting payments
    • Clinical documentation, e.g., patient reports, electronic medical record
    • Patient registration system
    • Checking patient’s eligibility
    • Verifying referral/prior authorization
    • Writing referrals
    • Writing orders
    • Encounter forms
    • Coding tools, e.g., “superbills”, programs, books, resource materials
    • Quality reporting
    • Public health reporting
    • Disease registry/disease management
    • Health insurance contracting
    • Laboratory systems
    • Where else?
  • Evaluate how ICD-10 will affect your practice
    • Identify the diagnoses most frequently used.
    • Look up these diagnoses and review the potential new codes for the best match.
  • Identify staff who work with ICD-9 codes and how their job relates to those codes.
    • Understand how your clinicians and coding/billing personnel communicate.
    • What words do they use to describe their routine protocols to medical coders/billers?
  • Identify possible work flow changes needed to implement ICD-10 codes (e.g., data collection forms, encounter forms, superbills)
    • Medical coding
    • Training for medical coders
    • Increased to time to process medical claims
    • Managing the increased queries for physicians and clinicians
    • Physicians and clinicians
    • Clinical documentation
    • Quality improvement
    • Case management
    • Information technology
    • Upgrades
    • Internally (home grown) developed applications
    • External applications (Review contracts for commercial information system applications)
    • Reporting
    • Generating reports
    • File exporting
    • Data entry
    • Inputing
    • File importing
    • Data warehousing
    • Decision support
    • Research
    • Financial management and revenue cycle
    • Productivity
    • Reimbursement Structures
    • Contract negotiations
    • New reimbursement policies
    • Pre-Authorization
    • Eligibility
    • Scheduling
    • Admitting/Registration
    • Charges, Coding
    • Claims/Billing
    • Collections/Follow-up
    • Payment Posting
    • Denials Management
    • Education/Training
    • Business practices
    • Referrals
    • Authorizations/pre-certifications
    • Patient intake
    • Physician orders
    • Patient encounters
    • Clinical documentation: The increased specificity will require that patient encounters are documented with with greater detail.
    • Impacts
    • Staff training
    • Physician workflow
    • Patient volume
    • Forms, documents, and encounter forms need to be revised to reflect ICD-10 codes
    • Processes for ordering and reporting lab/diagnostic services to health plans
    • Evaluate whether clinical documentation can support ICD-10 specificity
    • Prepare clinical documentation improvement (CDI) strategies
    • Identify how staff will enter key words, medical notes and content in medical records.
    • Determine if hiring a consultant is needed as a part of your implementation process
  • Figure out how much the ICD-10 transition will cost.
    • Focus on four areas:
    • Coding
    • Revenue cycle
    • Project management
    • IT
    • Each area requires resources - time and money - to accommodate:
    • Software and hardware
    • In house and vendor modifications
    • Upgrades
    • New software, systems and equipment
    • Education
    • Coder training
    • Clinician education
    • Awareness raising
    • Testing related costs
    • Staff time needed for:
    • Implementation planning
    • Training
    • Testing
    • Vendor management
    • Temp staffing to assist with extra work resulting from:
    • Decreased coding productivity
    • Billing backlogs
    • Claims denial and rejection management
    • IT work on upgrades and systems
    • Lost time during training
    • Consulting services
    • Forms and reports
    • Redesign
    • Printing costs
    • Data conversion
    • Dual coding
    • Added time
    • Maintaining data collection
    • Analyzing data
  • Plan training and education initiatives.
    • Assess needed training and education
    • Subjects
    • ICD-10 coding
    • Anatomy
    • Physiology
    • Pharmacology
    • Medical terminology
    • Procedures
    • Pick best training options
    • Formal classroom sessions
    • In-house sessions
    • Remote, online sessions
    • Identify which staff members will need what training
    • Three levels of training:
    • ICD-10 code training
    • Medical coders
    • ICD-10-CM/PCS code set
    • Anatomy and physiology refreshers
    • In-house trainers
    • Medical coder with ICD-10 training
    • Train co-workers
    • Dual coding
    • Assign ICD-9 codes and ICD-10 codes before Oct. 1, 2014
    • Advantages:
    • Medical coders can practice their ICD-10 knowledge
    • Clinical documentation deficiencies are exposed
    • Extensive internal and external testing can be done
    • Non-coding staff members
    • Educate IT staff about requirements and structure of ICD-10 code sets
    • Coding champion
    • Staff member with ICD-10 training
    • Educate and create awareness among the non-coding staff
    • Help understand what vendors are selling
    • Plan implementation and testing
    • Awareness
    • Start immediately
    • Create an education plan that fits their schedules and needs
    • Explain how their work with ICD-10 codes will affect reimbursement.
    • Assess what they need to know:
    • Major differences between ICD-9 codes and ICD-codes
    • ICD-10 cheat sheets
    • Regular communications with management, IT staff and medical staff about:
    • Differences between ICD-9 and ICD-10 code sets
    • Differences between ICD-10-CM and ICD-10-PCS code sets
    • Regulatory requirements
    • Value of ICD-10 code sets
    • How ICD-10 implementation works with other initiatives
    • Impact on coding productivity and accuracy
    • Budget impacts
    • How the transition will impact departments
    • Impact on physicians' time
    • How ICD-10 coding could affect patient encounters
    • Updates on progress of the ICD-10 transition
    • Recruit physicians and other clinicians to help champion your ICD-10 project. This has two key benefits:
    • Physicians and clinicians will be more influential in getting colleagues to cooperate. Which will come in handy when they learn they need to add more detail to documentation.
    • Physicians and clinicians can offer reality checks to how things really work in your practice. Something that the IT staff or consultants may not be aware of.
    • Consider expanding their coding skills and knowledge to make up for lost productivity.
    • Procedural training
    • New procedures and systems
    • How to use new software and tools
    • Electronic health records (EHRs)
    • Computer assisted coding (CAC) systems
    • Practice management systems
    • New forms such as superbills
    • New billing and claims procedures
    • New documentation procedures
    • Clinical documentation improvement (CDI) initiatives
    • Impact on documentation
    • CDI strategy
    • Schedule training
    • Arrange sessions for staff
    • Spread training so coding shifts covered
    • Plan training slots for yet-to-be hired personnel
    • Investigate training vendors
    • Budget resources
    • Cost of training sessions and materials
    • Time for staff members to learn.
    • Cost of staff or temp workers who cover while your people are in training sessions
    • Cost of outsourcing medical coding while staff coders are in training sessions
    • AHIMA training courses
    • Organization wide education (especially non-coding staff)
    • Awareness, preparation and awareness (up to three hours)
    • How ICD-10 implementation will affect the organization
    • Prepares everyone for ICD-10 implementation
    • Instructions for executives, clinicians and other staff
    • Practical training (four hours)
    • Introduction to ICD-10-CM/PCS code sets
    • How implementation tools work
    • HIM directors, IT staff and other staff
    • Coding training
    • Awareness (three to six hours)
    • ICD-10 overview
    • Assess readiness
    • Reinforce foundation training
    • Anatomy
    • Physiology
    • Pharmacology
    • Medical terminology
    • ICD-10-CM training (28 hours)
    • Introduction to coding system
    • Comprehensive diagnosis coding instructions
    • ICD-10-PCS training (23-28 hours)
    • Introduction to coding system
    • Comprehensive procedure coding instructions
    • Practice (AHIMA plans four hours per course)
    • Inpatient scenarios
    • Outpatient scenarios
    • Coding training for specialty settings
    • Awareness (three to six hours)
    • ICD-10 overview
    • Assess readiness
    • Reinforce foundation training
    • ICD-10-CM training (28 hours)
    • Introduction to coding system
    • Comprehensive coding instruction
    • Practice (AHIMA plans four hours per course)
    • Practice by specialty setting
It looks like a lot but it's doable. The goal is to understand what medical practices will need to do to be ready Oct.1.

In a nutshell, the rest of 2015 will be spent on:

  • Conduct training (Keep training until June 1 then practice)
    • Obtain Clinical Documentation Education Ongoing Practice and Validation
    • Obtain Coding Education
    • Obtain ICD-10 Overview Education
  • Update processes
    • Improve Clinical Documentation (through Oct. 1)
    • Revise Paper Forms and Templates (April 1 deadline)
    • Modify Policies and Procedure (April 1 deadline)
  • Engage vendors and payers (Aug. 1 deadline)
    • Engage Technology Vendors and Update Systems
    • Engage Staffing/Billing Vendors and Evaluate Readiness
    • Engage Clearinghouses and Evaulate Readiness
    • Engage Payers and Evaluate Readiness
  • Testing
    • Prepare Internal Testing of Systems and Processes (Should be done by now)
    • Perform Internal Testing of Systems and Processes (Should be done by now)
    • Conduct External Testing with Partners (Aug. 1 deadline)


We will tackle training next time.


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