May 16, 2011

Assess, Implement, Evaluate: ICD-10: An Opportunity to Improve your Organization

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ED. NOTE: This is Part 2 in a three-part series of articles on the impact of technology and ICD-10.

In Part 1 of this series I discussed the importance of performing an ICD-10 risk assessment at your facility sooner rather than later. What I have noticed is that some have begun, but many others have their heads buried in the sand. For those of you who have kept current and are trying to wrap your arms around this big undertaking, I’d like to share some implementation-related best practices I have learned from my fellow colleagues: in particular I will be focusing on the strategy and workflow processes you may want to consider as you implement ICD-10 at your facility.

I had the opportunity to attend the AHIMA ICD-10 Summit in April, and one remark that stood out to me indicated that almost every system in your facility will be affected by ICD-10, with the exception of housekeeping. “Really?” I thought to myself. Yes, really – one director of patient financial services spoke about more than 80 systems being affected at his facility. This same director’s strategy when it came to ICD-10 was to take the opportunity to improve the overall business practices of his organization, looking at ICD-10 as a “benefit” versus a “have to.” The organization developed a strategy in regard to ICD-10 that allowed it to better measure outcomes, enhance clinical care to promote wellness over time, begin accountable care organization (ACO) negotiation with contracting, consider the opportunity to earn stimulus funding by becoming early adopter of ICD-10, and provide physician education.

A big part of an effective strategy is organizing the effort around ICD-10 and developing project goals. Particularly, one of these common goals should be to establish a governing body. The governing body should take a “top down” approach, as leadership typically should lead the charge for change within a facility. This governing team will create a timeline and define responsibilities and priorities.

Some of the project goals also should include facilitating organizational awareness, support education and training, coordination of resources, understanding of reimbursement impact and the linkage of technology requirements with informational needs. The governing team will include moving parts, and not just leadership.

Whereas there will be some who serve as part of project management and focus on establishing project goals, an advisory team of key stakeholders will focus on outcomes, budget impact and continuous evaluation of those goals.

Furthermore, a steering committee will concentrate on impacted systems and departments, such as information technology, clinical and financial members.

There are many areas in your organization to think about from a technology perspective. Will all systems be go come Oct. 1, 2013? As you think about your strategy and workflow with regard to ICD-10, consider the following:

Information Technology - Understand how you currently do business under ICD-9.  There needs to be an assessment of all systems that utilize ICD-9 codes.

Check all systems with the exception of housekeeping.

-         Perform a system inventory of ICD-9 data storage.

-         Be 5010-ready.

-         Understand system transitions and conversions of historical data.


Reporting – Understand the reporting workflow impact of ICD-9 to ICD-10 and vice versa.

-         Identify all current reporting workflow processes that utilize ICD-9 data.

-         Assess which vendors are available to facilitate understanding of the comparisons from I-9 to I-10.

-         Identify what tools are available on the market to facilitate understanding of the transition process and assure that GEMS mapping available through CMS is part of the workflow tool assessment.

    • Perform a vendor readiness survey.

Finance - Understand what the reimbursement impact on your facility will be and assess payer readiness.

-         Assess payer contracts – now is the time to negotiate.

    • Negotiations should include preparing future contract language to include references to ICD-10.
    • Create a payer readiness survey.

-         Perform a reimbursement impact analysis (using reimbursement maps provided by CMS).

    • Recommend starting with top 10 DRGs at your facility.

Documentation – Understand your risk related to documentation. It is probable that documentation is a key area of risk due to the specificity involved in coding with ICD-10.

-         Recommend engaging a third-party vendor to review documentation.

    • Consider the ratio of records slated for review to hospital bed size:  review 100-200 records per 100-300 beds.
    • Review third-party documentation recommendations and identify gaps in current documentation processes; revise templates as warranted and educate physicians on documentation requirements.

Education – Identify training needs for all personnel. Training will be differentiated based on staff roles.

-         Start with ICD-10 educational awareness programs.

-         Identify methods, timing and depth of training by type of personnel.

    • Account for ongoing education and new staff training.

Team ICD-10 – Identify members who will drive all of the moving parts to implementation. For some, this is the steering committee.

-         This team needs to ensure that all areas that could be affected by ICD-10 are addressed.

-         Members must be involved in training and education, ensuring that every aspect of the transition is communicated clearly throughout the organization.

 


It’s overwhelming to say the least, but the implementation process needs to be addressed. As you look at your current workflow processes, you may want to modify your current workflow or revamp it completely. It truly depends on how well your current processes work under ICD-9. Just remember that implementing ICD-10 is a work in progress and you can and will need to be flexible.

Ultimately, change can be good, as it often provides an opportunity to improve.

About the Author

Maria T. Bounos, RN, MPM, CPC-H, is the Business Development Manager for Regulatory and Reimbursement software solutions for Wolters Kluwer.  Maria began her career at Wolters Kluwer as a product manager, responsible for product development, maintenance, enhancements and business development and now solely focuses on business development.  She has more than twenty years of experience in healthcare including nursing, coding, healthcare consulting, and software solutions.

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Read 22 times Updated on September 23, 2013
Maria Bounos, RN, MPH, CPC-H

Maria T. Bounos, RN, MPM, CPC-H, is the practice lead for coding and reimbursement software solutions for Wolters Kluwer.  Maria began her career at Wolters Kluwer as a product manager, responsible for product development, maintenance, enhancements and business development and now solely focuses on business development.  She has more than twenty years of experience in healthcare including nursing, coding, healthcare consulting, and software solutions.